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NPI Code Detail

MEDICARE: MISTY AVILA FNP

MEDICARE: MISTY AVILA FNP
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
1363LF0000XFamily Nurse Practitioner1096240TX

General Provider Information

NPI Number : 1295450641
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY AVILA FNP
Provider Business Mailing Address
First Line : 4674 MCDERMOTT RD STE 308
Second Line :
City : PLANO
State : TX
Zip : 75024-7797
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4674 MCDERMOTT RD STE 308
Second Line :
City : PLANO
State : TX
Zip : 75024-7797
Country : US
Telephone Number : 972-424-4243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2022
Last Update Date : 10/07/2022

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