MEDICARE: ANGEL LIVINGSTON APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	1143620	TX
2	363L00000X	Nurse Practitioner	219517	AR

General Provider Information

NPI Number	:	1063156420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL LIVINGSTON APRN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 735863
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-5863
Country	:	US
Telephone Number	:	281-888-8999
Fax Number	:	281-305-4054

Provider Business Practice Location Address
First Line	:	1924 FOREST RIDGE DRIVE
Second Line	:	STE 300
City	:	BEDFORD
State	:	TX
Zip	:	76021-8228
Country	:	US
Telephone Number	:	281-888-8999
Fax Number	:	281-305-4054

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

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	07/24/2024

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