Provider Demographics
NPI:1053614313
Name:GANN, PRISCILLA C (PA-C, MPAS)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:C
Last Name:GANN
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:C
Other - Last Name:MECHENBIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 51389
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1389
Mailing Address - Country:US
Mailing Address - Phone:806-353-7000
Mailing Address - Fax:
Practice Address - Street 1:6842 PLUM CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1601
Practice Address - Country:US
Practice Address - Phone:806-353-7000
Practice Address - Fax:806-356-1147
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant