MEDICARE: MICHAEL JARED HESTER AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP135414	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	662202	OTHER	TX	TX MEDICARE

General Provider Information

NPI Number	:	1275044422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JARED HESTER AGACNP-BC

Provider Business Mailing Address
First Line	:	4214 ANDREWS HWY STE 240
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79703-4817
Country	:	US
Telephone Number	:	432-686-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 ROSALIND REDFERN GROVER PKWY STE 200
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79701-5852
Country	:	US
Telephone Number	:	432-221-2107
Fax Number	:	432-682-1707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2017
Last Update Date	:	09/02/2020

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