=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689501728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE LOPEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2026
-----------------------------------------------------
Last Update Date | 05/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 S HILLSIDE DR STE 5
-----------------------------------------------------
City | BEEVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78102-5324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-362-0307
-----------------------------------------------------
Fax | 361-492-5521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 E 1ST ST
-----------------------------------------------------
City | ALICE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78332-4822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-664-0145
-----------------------------------------------------
Fax | 361-664-2248
-----------------------------------------------------
=====================================================
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 | 1231677
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------