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NPI Code Detail

MEDICARE: MIKE MANIS JR.

MEDICARE: MIKE MANIS JR.
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
1363LF0000XFamily Nurse PractitionerAP1007851TX
2363L00000XNurse PractitionerAP1007851TX

General Provider Information

NPI Number : 1477165546
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKE MANIS JR.
Provider Business Mailing Address
First Line : 16110 CELEBRATION LN
Second Line :
City : CYPRESS
State : TX
Zip : 77433-8080
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2626 S LOOP W STE 265
Second Line :
City : HOUSTON
State : TX
Zip : 77054-5636
Country : US
Telephone Number : 713-796-9955
Fax Number : 281-845-9498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2020
Last Update Date : 03/10/2026

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