MEDICARE: TEXAS NURSE ADVOCATE PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LG0600X	Gerontology Nurse Practitioner
2	363LW0102X	Women's Health Nurse Practitioner
3	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1720791056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS NURSE ADVOCATE PLLC

Provider Business Mailing Address
First Line	:	23910 W INTERSTATE 10 APT 4209
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1387
Country	:	US
Telephone Number	:	210-601-9034
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 OLD SAN ANTONIO RD STE 202
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-3495
Country	:	US
Telephone Number	:	830-331-9880
Fax Number	:	210-519-3012

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MICHELLE ANNE MOURRE
Credential	:
Telephone Number	:	210-601-9034

Provider Enumeration Date	:	01/02/2023
Last Update Date	:	03/10/2024

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