=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538701180
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE ANN ACEVEDO APRN,MSN,FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2019
-----------------------------------------------------
Last Update Date | 11/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 AUSTIN ST
-----------------------------------------------------
City | LEVELLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79336-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-310-2715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 AUSTIN ST
-----------------------------------------------------
City | LEVELLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79336-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-310-2715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP143449
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------