Provider Demographics
NPI:1083284541
Name:MABBITT, MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MABBITT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 CIBOLO VALLEY DR STE 113
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4551
Mailing Address - Country:US
Mailing Address - Phone:281-783-8162
Mailing Address - Fax:281-895-3083
Practice Address - Street 1:784 CIBOLO VALLEY DR STE 113
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-4551
Practice Address - Country:US
Practice Address - Phone:281-783-8162
Practice Address - Fax:281-895-3083
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily