Basic Information
| Provider Information | |||||||||
| NPI: | 1306847587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINTERS | ||||||||
| FirstName: | TRICIA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4513 WILLIAMS DR | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786331302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129303909 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1464 E WHITESTONE BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786139058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122603376 | ||||||||
| FaxNumber: | 5122601177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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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 | 363AM0700X | PA03782 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.