Provider Demographics
NPI:1366488546
Name:AHMED, PAMELA A (PA C)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:AHMED
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 1:3901 TREEMONT CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8718
Mailing Address - Country:US
Mailing Address - Phone:407-302-0089
Mailing Address - Fax:817-934-2278
Practice Address - Street 1:2925 LBJ FRWY
Practice Address - Street 2:#100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234
Practice Address - Country:US
Practice Address - Phone:972-280-0080
Practice Address - Fax:972-280-0081
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01673363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S68946Medicare UPIN