Basic Information
| Provider Information | |||||||||
| NPI: | 1750784948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVE | ||||||||
| FirstName: | AKISHA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6451 BRENTWOOD STAIR RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761123200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174969700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8200 WALNUT HILL LN | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174969700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2014 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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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.