Healthcare Provider Details

I. General information

NPI: 1134876485
Provider Name (Legal Business Name): JOHN MICHAEL MCINTYRE APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROY RIVERS RD
ELGIN TX
78621-2072
US

IV. Provider business mailing address

200 ROY RIVERS RD
ELGIN TX
78621-2072
US

V. Phone/Fax

Practice location:
  • Phone: 737-200-6400
  • Fax: 737-200-6405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09211225
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF09211225
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: