1609152255 NPI number — MRS. AMBER HANKS EBNER PA-C

Table of content: MRS. AMBER HANKS EBNER PA-C (NPI 1609152255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609152255 NPI number — MRS. AMBER HANKS EBNER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBNER
Provider First Name:
AMBER
Provider Middle Name:
HANKS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANKS
Provider Other First Name:
AMBER
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609152255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXAHACHIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75165-3235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-937-5252
Provider Business Mailing Address Fax Number:
972-937-5259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAXAHACHIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75165-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-937-5252
Provider Business Practice Location Address Fax Number:
972-937-5259
Provider Enumeration Date:
10/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA07466 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA07466 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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