MEDICARE: YESHIMEBET AYALEW MESHESHA FNP

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	AP134816	TX

General Provider Information

NPI Number	:	1356853220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESHIMEBET AYALEW MESHESHA FNP

Provider Business Mailing Address
First Line	:	3333 BAYSHORE BLVD STE 310
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1950
Country	:	US
Telephone Number	:	713-589-7058
Fax Number	:	713-589-9623

Provider Business Practice Location Address
First Line	:	3333 BAYSHORE BLVD STE 310
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1950
Country	:	US
Telephone Number	:	713-589-7058
Fax Number	:	866-215-1550

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

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	03/17/2018

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