Provider Demographics
NPI:1053599852
Name:GILL, KIRANPAL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KIRANPAL
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26265 NORTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1760
Mailing Address - Country:US
Mailing Address - Phone:330-607-0440
Mailing Address - Fax:401-652-9787
Practice Address - Street 1:26265 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1760
Practice Address - Country:US
Practice Address - Phone:330-607-0440
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09065363A00000X
PAMA053334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant