Provider Demographics
NPI:1225162316
Name:NISTAL, LOUIS F (PA-C)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:F
Last Name:NISTAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14041 NORTHWEST BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5137
Mailing Address - Country:US
Mailing Address - Phone:361-767-9963
Mailing Address - Fax:361-767-8477
Practice Address - Street 1:9708 BUSINESS PKWY
Practice Address - Street 2:118
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4742
Practice Address - Country:US
Practice Address - Phone:210-372-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05111363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193260001Medicaid
TX193260001Medicaid