Healthcare Provider Details

I. General information

NPI: 1295262178
Provider Name (Legal Business Name): PHILOMENA HAMILTON MISTRETTA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HIGHLAND AVE
SHERMAN TX
75092-7354
US

IV. Provider business mailing address

7500 RIALTO BLVD STE 1-140
AUSTIN TX
78735-8534
US

V. Phone/Fax

Practice location:
  • Phone: 903-870-4690
  • Fax: 888-730-1925
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number745852
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: