Provider Demographics
NPI:1447691944
Name:ALLRED, JOSHUA JAMES (PA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAMES
Last Name:ALLRED
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 ALTAMESA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-5475
Mailing Address - Country:US
Mailing Address - Phone:817-854-9969
Mailing Address - Fax:803-604-0854
Practice Address - Street 1:5900 ALTAMESA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-5475
Practice Address - Country:US
Practice Address - Phone:817-854-9969
Practice Address - Fax:803-604-0854
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08526363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324531803Medicaid
8244NDOtherBCBS
8244NDOtherBCBS
TX310729YR7EMedicare PIN
TX3245318-01Medicaid