Individual provider Active NPI

Tiarra Rachell Davis, PA-C

  • Physician Assistant
  • Dallas, TX
National Provider Identifier
1134880693
Registry record updated Jan 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3600 Gaston Ave
Dallas, TX 75246-1800
Phone
(214) 821-1177
NPI assigned
Jan 6, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X TX Primary

Addresses

Primary practice location

3600 Gaston Ave
Dallas, TX 75246-1800

Mailing address

5415 Maple Ave Apt 303
Dallas, TX 75235-7496
Phone (903) 658-4378

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220411001908 TX Practitioner - Physician Assistant 9739575150 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Mar 28, 2022 Accepting new patients
Healthtexas Provider Network CurrentSince Mar 28, 2022 Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

3600 Gaston Ave
Dallas, TX 75246
Phone (214) 820-7246

301 N Washington Ave
Dallas, TX 75246
Phone (469) 800-8330

3600 Gaston Ave
Ste 550
Dallas, TX 75246
Phone (214) 821-1177

Interoperability endpoints

  • Direct secure messaging: tthomas949974@direct.sw.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705708800000",
    "number": "1134880693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5415 MAPLE AVE APT 303",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357496",
            "telephone_number": "903-658-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 GASTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461800",
            "telephone_number": "214-821-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TIARRA",
        "middle_name": "RACHELL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-06",
        "last_updated": "2024-01-20",
        "certification_date": "2024-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.