Provider Demographics
NPI:1790126738
Name:JOUETT, NICOLE BUSTAMANTE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:BUSTAMANTE
Last Name:JOUETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6750 N MACARTHUR BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2831
Mailing Address - Country:US
Mailing Address - Phone:972-373-0303
Mailing Address - Fax:972-373-8074
Practice Address - Street 1:6750 N MACARTHUR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2831
Practice Address - Country:US
Practice Address - Phone:972-373-0303
Practice Address - Fax:972-373-8074
Is Sole Proprietor?:No
Enumeration Date:2013-07-06
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX749772363LF0000X
TXAP123935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily