Basic Information
| Provider Information | |||||||||
| NPI: | 1194029561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLOUGHBY | ||||||||
| FirstName: | AMBROSIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3533 MATLOCK RD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760153604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174190303 | ||||||||
| FaxNumber: | 8174685963 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 ORTHOPEDIC WAY | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760151629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173755200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2010 | ||||||||
| LastUpdateDate: | 04/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.