Provider Demographics
NPI:1093392987
Name:BARROSO, MAYERY (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAYERY
Middle Name:
Last Name:BARROSO
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 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:6428 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1511
Practice Address - Country:US
Practice Address - Phone:210-520-4455
Practice Address - Fax:210-520-4421
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1024054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily