Provider Demographics
NPI:1871869099
Name:MCPHERSON, GLORIA (PA-C)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:MCPHERSON
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 1:3556 ASHMERE LOOP
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1014
Mailing Address - Country:US
Mailing Address - Phone:512-466-1455
Mailing Address - Fax:
Practice Address - Street 1:1190 CHICON ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2100
Practice Address - Country:US
Practice Address - Phone:512-241-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA-01992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant