Look up the most recent NPI and PECOS records

Gator Pa 1st Assist, Llc

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

10900 Stonelake Blvd Ste A-320, Austin, TX 78759-5833

PECOS Enrollment

Based on the most recent information from CMS, provider Gator Pa 1st Assist, Llc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1508102559
Provider Type
Organization
Full Name
Gator Pa 1st Assist, Llc

Subpart
No
Enumeration Date
12/19/2012
Last Updated
12/19/2012

Contact Information

Practice Location

10900 Stonelake Blvd Ste A-320, Austin, TX 78759-5833

(866) 698-0052

Unlisted Fax

Mailing Location

10900 Stonelake Blvd Ste A-320, Austin, TX 78759-5833

(866) 698-0052

Unlisted Fax

Authorized Official

Ahmed, Pamela Ann (Owner)

(972) 814-6341

Provider Taxonomies

Code	Description	License
Code 363AS0400X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA01673 Texas

Gator Pa 1st Assist, Llc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Harrell, Kirstin Brooke

Brooks, Joshua Ryan

Crumley, Brinley Christine

Bush, Jared W

Silva, Adam Jeffrey

Lopez, Jerry

Deford, Kathryn Storey

Alexander, Kathryn Drew

Cronin, Lisa Anne

Pickering Wolski, Jeanelle Denise