MEDICARE: NICOLE A. MUELLER P.A.

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	207W00000X	Ophthalmology Physician		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861491037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE A. MUELLER P.A.

Provider Business Mailing Address
First Line	:	1201 MEDICAL PLAZA CT
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-5684
Country	:	US
Telephone Number	:	817-279-9333
Fax Number	:	817-573-6234

Provider Business Practice Location Address
First Line	:	1201 MEDICAL PLAZA CT
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-5684
Country	:	US
Telephone Number	:	817-279-9333
Fax Number	:	817-573-6234

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NICOLE ALISON MUELLER
Credential	:	DO
Telephone Number	:	817-279-9333

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/21/2022

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