Healthcare Provider Details

I. General information

NPI: 1770873077
Provider Name (Legal Business Name): MICHELLE BEATRICE OCONNOR CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 CANNON DR
MANSFIELD TX
76063-3482
US

IV. Provider business mailing address

1825 CANNON DR
MANSFIELD TX
76063-3482
US

V. Phone/Fax

Practice location:
  • Phone: 817-453-7770
  • Fax: 817-453-7703
Mailing address:
  • Phone: 817-453-7770
  • Fax: 817-453-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number541137
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: