Provider Demographics
NPI:1043496110
Name:MCCALL-PRESTON, ELISHA
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:MCCALL-PRESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:3150 CLARKSVILLE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-8076
Mailing Address - Country:US
Mailing Address - Phone:903-782-9206
Mailing Address - Fax:903-783-7367
Practice Address - Street 1:3150 CLARKSVILLE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-8076
Practice Address - Country:US
Practice Address - Phone:903-782-9206
Practice Address - Fax:903-783-7367
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630820363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics