Provider Demographics
NPI:1477515864
Name:BACHMAN, CHANGIL LEE (FNP)
Entity Type:Individual
Prefix:MR
First Name:CHANGIL
Middle Name:LEE
Last Name:BACHMAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 ELDORADO PKWY, BOX 150-153
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033
Mailing Address - Country:US
Mailing Address - Phone:469-598-1200
Mailing Address - Fax:972-637-9272
Practice Address - Street 1:12361 BARKER CYPRESS RD.
Practice Address - Street 2:STE 800
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:281-213-5198
Practice Address - Fax:913-632-9909
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX715127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171954401Medicaid
TX00Y094Medicare PIN
TX8L9213Medicare PIN
TX171954401Medicaid
TX8K2997Medicare PIN
TXP50324Medicare UPIN
TX8L9215Medicare PIN
TX8F6045Medicare PIN
TX8D2393Medicare ID - Type Unspecified
TX8L9214Medicare PIN