Provider Demographics
NPI:1619728797
Name:SEDEK, MISHEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:MISHEL
Middle Name:
Last Name:SEDEK
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 1:100 KIOWA DR W APT 103
Mailing Address - Street 2:
Mailing Address - City:LAKE KIOWA
Mailing Address - State:TX
Mailing Address - Zip Code:76240-9507
Mailing Address - Country:US
Mailing Address - Phone:940-612-5562
Mailing Address - Fax:940-665-6201
Practice Address - Street 1:100 KIOWA DR W APT 103
Practice Address - Street 2:
Practice Address - City:LAKE KIOWA
Practice Address - State:TX
Practice Address - Zip Code:76240-9507
Practice Address - Country:US
Practice Address - Phone:940-612-5562
Practice Address - Fax:940-665-6201
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily