Provider Demographics
NPI:1487389706
Name:CROSS, AVERY VICTORIA (PA)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:VICTORIA
Last Name:CROSS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23119 W INTERSTATE 10 STE 904
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1767
Mailing Address - Country:US
Mailing Address - Phone:210-944-8855
Mailing Address - Fax:
Practice Address - Street 1:23119 W INTERSTATE 10 STE 904
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1767
Practice Address - Country:US
Practice Address - Phone:210-944-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant