=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861491037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICOLE A. MUELLER P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 MEDICAL PLAZA CT
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-5684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-279-9333
-----------------------------------------------------
Fax | 817-573-6234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 MEDICAL PLAZA CT
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-5684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-279-9333
-----------------------------------------------------
Fax | 817-573-6234
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. NICOLE ALISON MUELLER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 817-279-9333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------