Provider Demographics
NPI:1366607301
Name:IPE, SIBI VARGHESE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SIBI
Middle Name:VARGHESE
Last Name:IPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SIBI
Other - Middle Name:VARGHESE
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1105 CENTRAL EXPY N STE 235
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6135
Mailing Address - Country:US
Mailing Address - Phone:972-747-6042
Mailing Address - Fax:972-747-6043
Practice Address - Street 1:1105 CENTRAL EXPY N STE 235
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6135
Practice Address - Country:US
Practice Address - Phone:972-747-6042
Practice Address - Fax:972-747-6043
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP05723OtherMEDICAL LICENSE