MEDICARE: BABCOCK HEALTH & WELLNESS CLINIC

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	625986	TX

General Provider Information

NPI Number	:	1851738264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BABCOCK HEALTH & WELLNESS CLINIC

Provider Business Mailing Address
First Line	:	6423 BABCOCK RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2950
Country	:	US
Telephone Number	:	210-392-0385
Fax Number	:	830-368-5011

Provider Business Practice Location Address
First Line	:	6423 BABCOCK RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2950
Country	:	US
Telephone Number	:	210-392-0385
Fax Number	:	830-368-5011

Authorized Official
Title or Position	:	PRESIDENT/NURSE PRACTITIONER
Name	:	MS. MELISSA G HERNANDEZ
Credential	:	APRN FNP-BC
Telephone Number	:	210-392-0385

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	05/24/2013

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