MRS. MIRANDA DEBORD WILLETTE (NPI# 1578839593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578839593 |
| Entity Type | Individual |
| Full Name | MRS. MIRANDA DEBORD WILLETTE |
| Credential | PA-C |
| Practice Address |
12702 Toepperwein Suite 104 San Antonio TX 78233 |
| Practice Telephone | 2106534420 |
| Practice Fax Number | 2106533183 |
| Mailing Telephone | 2106534420 |
| Mailing Fax Number | 2106533183 |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2014-06-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA07761 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | DEA | MW2633255 | 01 |
| TX | DPS | R0187954 | 01 |
| TX | CAQH | 12370726 | 01 |
| TX | MEDICAL LICENSE | PA07761 | 01 |
| Street Address |
12702 TOEPPERWEIN SUITE 104 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78233 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396777868 | Occupational Health Centers of The Southwest, P.a. | Clinic/Center | 12702 Toepperwein, Suite 104, San Antonio, TX 78233 | 2006-07-07 |
| 1003202706 | American Current Care Pa | Clinic/Center | 12702 Toepperwein, Suite 120, San Antonio, TX 78233 | 2015-04-09 |
| 1922257963 | Concentra Health Services, Inc. | Clinic/Center | 12702 Toepperwein, Suite 104, San Antonio, TX 78233-3278 | 2008-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162451 | Jennifer Chaghoury | Chore Provider | 4606 La Marquesa St, San Antonio, TX 78233 | 2020-07-27 |
| 1912515719 | Creative Health Care Management, LLC | Physical Therapist | 4415 Rio D'oro St, San Antonio, TX 78233 | 2020-07-17 |
| 1841822749 | Edilma Yosmara Medrano | Nurse's Aide | 209 Goforth Drive, San Antonio, TX 78233 | 2020-02-07 |
| 1578194411 | Jorge Javier Jaramillo De La Torre | Neurological Surgery | Cuauhtemoc 380, Col. Moderna, San Luis Potosi, SLP 78233 | 2020-01-29 |
| 1174182000 | Shenila Rajani Od Pllc | Optometrist | 12349 I-35, San Antonio, TX 78233 | 2019-06-13 |
| 1659935609 | Mff Amber Oaks LLC | Assisted Living Facility | 4415 Rio Doro St., San Antonio, TX 78233 | 2019-04-25 |
| 1457862302 | Antoinette Marie Powell | Massage Therapist | 14615 Interstate 35 N, Live Oak, TX 78233 | 2017-10-18 |
| 1154852150 | Dustin William Koenning | Pharmacist | 6019 Randolph Blvd., San Antonio, TX 78233 | 2017-03-22 |
| 1316481153 | U S Anesthesia Partners of Texas, Pa | Physician Assistant | 12602 Toepperwein Rd Ste 218, Live Oak, TX 78233 | 2016-12-13 |
| 1477096121 | Vanessa's Garden of Hope Assisted Living,llc | Assisted Living Facility | 4350 Shallow Water, San Antonio, TX 78233 | 2016-11-29 |
| Find all providers in zip 78233 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447866298 | Diana P Olivares | Physician Assistant | 8920 Quihi Way, San Antonio, TX 78254-1901 | 2020-09-17 |
| 1740893445 | Mcrm Assist, Pllc | Physician Assistant | 14546 Brook Hollow Blvd # 417, San Antonio, TX 78232-3810 | 2020-08-24 |
| 1508476086 | Matthew Gaines | Physician Assistant | 2626 Bluff Xing, San Antonio, TX 78244-1000 | 2020-08-09 |
| 1235757519 | Joseph Dominic Wechsler Jr. | Physician Assistant | 9114 Autumn Skies, San Antonio, TX 78254-1929 | 2020-07-13 |
| 1396368015 | Maureen Genov | Physician Assistant | 540 Madison Oak Dr Ste 450, San Antonio, TX 78258-3932 | 2020-05-28 |
| 1386266062 | Sun Assist, Pllc | Physician Assistant | 10650 Culebra Rd # 104-484, San Antonio, TX 78251-4949 | 2020-05-15 |
| 1134758964 | Mark Lee Nentwig | Physician Assistant | 1434 E Sonterra Blvd Ste 206, San Antonio, TX 78258-4973 | 2020-04-03 |
| 1962034694 | Christina L Russell | Physician Assistant | 525 Oak Centre Dr Ste 100, San Antonio, TX 78258-3916 | 2020-02-11 |
| 1265071203 | Caralyne Sandquist | Physician Assistant | 5510 Presidio Parkway, Building #2 Suite 2401, San Antonio, TX 78249 | 2019-12-21 |
| 1447808498 | Elizabeth Ann Blair | Physician Assistant | 24623 Birdie Rdg, San Antonio, TX 78260-7847 | 2019-09-03 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78233 |
Please comment or provide details below to improve the information on MRS. MIRANDA DEBORD WILLETTE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.