Provider Demographics
NPI:1053972471
Name:HOMEYER, SYDNEE A (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEE
Middle Name:A
Last Name:HOMEYER
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 1:4131 S BUCKNER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-4318
Mailing Address - Country:US
Mailing Address - Phone:214-388-0202
Mailing Address - Fax:214-388-0214
Practice Address - Street 1:4131 S BUCKNER BLVD STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-4318
Practice Address - Country:US
Practice Address - Phone:214-388-0202
Practice Address - Fax:214-388-0214
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA12861OtherTMB LICENSE