Individual provider Active NPI

Audra Cantrell, PA

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1396088985
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA08512 Issued in TX
Practice address
2405 W Drew St
Fort Worth, TX 76110-5915
Phone
(817) 733-2608
NPI assigned
Apr 1, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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 PA08512 TX Primary

Addresses

Primary practice location

2405 W Drew St
Fort Worth, TX 76110-5915

Mailing address

5219 City Bank Pkwy Ste 35
Lubbock, TX 79407-3545
Phone (806) 761-0334

Other practice location 1

602 Indiana Ave
Lubbock, TX 79415-3364
Phone (806) 775-9700

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
I20130924000566 TX Practitioner - Physician Assistant 2062656572 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umc PhysiciansGroup PAC ID 9830003631, 107 clinicians
Lubbock County Hospital DistrictGroup PAC ID 4284617507, 65 clinicians

Practice addresses (Care Compare)

6002 Slide Rd
D24
Lubbock, TX 79414-4310
Phone (806) 761-0450

602 Indiana Ave
Lubbock, TX 79415-3364
Phone (806) 775-9700

808 Joliet Ave
Unit 110
Lubbock, TX 79415-1148
Phone (806) 761-0545

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA08512TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lubbock County Hospital District CurrentSince Jan 7, 2026 Accepting new patients
Umc Physicians Physician Assistant CurrentSince Mar 28, 2018 Accepting new patients

Locations

808 Joliet Ave
Lubbock, TX 79415
Phone (806) 722-7400

11011 Slide Rd
Lubbock, TX 79424
Phone (806) 743-2584

5219 City Bank Pkwy
Ste 35
Lubbock, TX 79407
Phone (806) 761-0334

602 Indiana Ave
Lubbock, TX 79415
Phone (806) 743-2898

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1396088985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 CITY BANK PKWY STE 35",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794073545",
            "telephone_number": "806-761-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 W DREW ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761105915",
            "telephone_number": "817-733-2608"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "602 Indiana Ave",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794153364",
            "country_code": "US",
            "telephone_number": "806-775-9700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANTRELL",
        "first_name": "AUDRA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-01",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.