Provider Demographics
NPI:1174210785
Name:AUBOURG, PATCHIKA M (PA-C)
Entity type:Individual
Prefix:
First Name:PATCHIKA
Middle Name:M
Last Name:AUBOURG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HAWKINS RUN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-6670
Mailing Address - Country:US
Mailing Address - Phone:954-665-0925
Mailing Address - Fax:
Practice Address - Street 1:450 HAWKINS RUN RD STE 1
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6670
Practice Address - Country:US
Practice Address - Phone:682-900-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18818207VG0400X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant