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General NPI Number Information
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NPI Number | 1669086377
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Entity Type | Individual
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Provider Name | MICHELLE LYNN SELF
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Gender | Female
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 12500 JUDSON RD STE 210
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City | LIVE OAK
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State | TX
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Zip | 78233-4146
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Country | US
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Telephone | 210-878-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 12602 TOEPPERWEIN RD STE 208
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City | LIVE OAK
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State | TX
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Zip | 78233-3271
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Country | US
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Telephone |
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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 | AP145664
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | AP145664
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License Number State | TX
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