Provider Demographics
NPI:1033108485
Name:NESBITT, MICHAEL EDGAR (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDGAR
Last Name:NESBITT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1900 BARTON SPRINGS RD UNIT 5030
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1471
Mailing Address - Country:US
Mailing Address - Phone:512-828-6997
Mailing Address - Fax:512-476-4178
Practice Address - Street 1:2008 NINE RD
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-7210
Practice Address - Country:US
Practice Address - Phone:210-602-6719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05882363A00000X
NC1047135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant