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General NPI Number Information
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NPI Number | 1245034594
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Entity Type | Individual
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Provider Name | ANNIE BISTA APRN
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Gender | Female
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1224 N HIGHWAY 377 STE 213
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City | ROANOKE
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State | TX
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Zip | 76262-9109
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Country | US
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Telephone | 682-549-2022
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Fax | 512-782-9316
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Provider Business Mailing Address
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Address Line | 1224 N HIGHWAY 377 STE 213
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City | ROANOKE
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State | TX
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Zip | 76262-9109
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Country | US
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Telephone | 682-549-2022
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Fax | 512-782-9316
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1089419
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License Number State | TX
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