Provider Demographics
NPI:1881688471
Name:VAN ARK, JURRY E (PA-C)
Entity type:Individual
Prefix:
First Name:JURRY
Middle Name:E
Last Name:VAN ARK
Suffix:
Gender:M
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 1:325 CENTRAL EXPY S
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2786
Mailing Address - Country:US
Mailing Address - Phone:214-785-7246
Mailing Address - Fax:214-786-7606
Practice Address - Street 1:325 CENTRAL EXPY S
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2786
Practice Address - Country:US
Practice Address - Phone:214-785-7246
Practice Address - Fax:214-785-7606
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2025-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04200363A00000X, 363AM0700X
MO2025014310363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216379203Medicaid
TX216379202Medicaid
TX216379204Medicaid
TXP01233936OtherRAILROAD MCARE
TX216379201Medicaid
TX8Y1192OtherBLUE CROSS BLUE SHIELD
TX216379202Medicaid
CAPA17380Medicaid
TXTXB131869Medicare PIN
TX8Y1192OtherBLUE CROSS BLUE SHIELD
TX216379203Medicaid
TXTXB109743Medicare PIN
TX216379201Medicaid