Active NPI
Tiny Phan
- Physician Assistant
- Amarillo, TX
National Provider Identifier
1104644467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA19842
- Practice address
- 2021 Evergreen St
Amarillo, TX 79107-7551 - Phone
- (806) 236-2321
- NPI assigned
- Sep 26, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA19842 | TX | Primary |
Addresses
Primary practice location
2021 Evergreen St
Amarillo, TX 79107-7551
Mailing address
2021 Evergreen St
Amarillo, TX 79107-7551
Phone (806) 236-2321
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of Oklahoma College of Medicine, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1622 Wildflower Dr
Waxahachie, TX 75165-7839
2909 S Hampton Rd
Suite D107
Dallas, TX 75224-3000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA19842 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768953600000",
"number": "1104644467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2021 EVERGREEN ST",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791077551",
"telephone_number": "806-236-2321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2021 EVERGREEN ST",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791077551",
"telephone_number": "806-236-2321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "TINY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-26",
"last_updated": "2026-01-21",
"certification_date": "2026-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA19842",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.