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General NPI Number Information
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NPI Number | 1033108485
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Entity Type | Individual
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Provider Name | MICHAEL EDGAR NESBITT PA
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 2008 NINE RD
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City | BRADY
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State | TX
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Zip | 76825-7210
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Country | US
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Telephone | 210-602-6719
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 BARTON SPRINGS RD UNIT 5030
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City | AUSTIN
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State | TX
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Zip | 78704-1471
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Country | US
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Telephone | 512-828-6997
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Fax | 512-476-4178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA05882
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1047135
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License Number State | NC
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