Individual provider Active NPI

Miranda Nicole Martinez, PA

  • Physician Assistant
  • Mission, TX
National Provider Identifier
1588033922
Registry record updated Sep 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA09950 Issued in TX
Practice address
1300 S Bryan Rd Ste 107
Mission, TX 78572-6688
Phone
(956) 603-1557
Fax
(956) 646-1157
NPI assigned
Sep 16, 2015
Last updated
Sep 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 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 PA09950 TX Primary

Addresses

Primary practice location

1300 S Bryan Rd Ste 107
Mission, TX 78572-6688

Mailing address

1300 S Bryan Rd Ste 107
Mission, TX 78572-6688
Phone (956) 603-1557

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
I20160120000516 TX Practitioner - Physician Assistant 0941503205 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA09950TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Frontier Direct Care Pharr CurrentSince Apr 27, 2025 Accepting new patients

Locations

114 W Cherokee Ave
Pharr, TX 78577
Phone (956) 666-1854

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789776000000",
    "number": "1588033922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 S BRYAN RD STE 107",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785726688",
            "telephone_number": "956-603-1557",
            "fax_number": "956-646-1157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S BRYAN RD STE 107",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785726688",
            "telephone_number": "956-603-1557",
            "fax_number": "956-646-1157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "MIRANDA",
        "middle_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-16",
        "last_updated": "2026-09-19",
        "certification_date": "2026-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission, TX

Sources for this page

Verify at the official NPI Registry.