Provider Demographics
NPI:1477218642
Name:CALVERT, MICHAEL LESLIE (APRN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LESLIE
Last Name:CALVERT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13363 COUNTY ROAD 477
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-6808
Mailing Address - Country:US
Mailing Address - Phone:469-323-4306
Mailing Address - Fax:
Practice Address - Street 1:13363 COUNTY ROAD 477
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-6808
Practice Address - Country:US
Practice Address - Phone:469-323-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10210702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily