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General NPI Number Information
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NPI Number | 1346987674
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Entity Type | Individual
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Provider Name | PHIL BOME
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Gender | Male
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 5040 TENNYSON PKWY
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City | PLANO
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State | TX
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Zip | 75024-3002
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Country | US
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Telephone | 469-265-4748
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Fax |
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Provider Business Mailing Address
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Address Line | 9976 BRADFORD GROVE DR
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City | FRISCO
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State | TX
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Zip | 75035-3003
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Country | US
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Telephone | 469-585-5166
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Fax |
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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 | 1076988
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License Number State | TX
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