Provider Demographics
NPI:1578812434
Name:BISTA, BHAWANA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:BHAWANA
Middle Name:
Last Name:BISTA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6406 N INTERSTATE 35 STE 2600
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-4337
Mailing Address - Country:US
Mailing Address - Phone:512-465-4800
Mailing Address - Fax:512-420-0118
Practice Address - Street 1:6406 N INTERSTATE 35 STE 2600
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-4337
Practice Address - Country:US
Practice Address - Phone:512-465-4800
Practice Address - Fax:512-420-0118
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128177363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily