MEDICARE: MICHAEL EDGAR NESBITT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA05882	TX
2	363A00000X	Physician Assistant	1047135	NC

General Provider Information

NPI Number	:	1033108485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL EDGAR NESBITT PA

Provider Business Mailing Address
First Line	:	1900 BARTON SPRINGS RD UNIT 5030
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-1471
Country	:	US
Telephone Number	:	512-828-6997
Fax Number	:	512-476-4178

Provider Business Practice Location Address
First Line	:	2008 NINE RD
Second Line	:
City	:	BRADY
State	:	TX
Zip	:	76825-7210
Country	:	US
Telephone Number	:	210-602-6719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	06/16/2020

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