Provider Demographics
NPI:1922234384
Name:BACOT, ISABELL (PA)
Entity Type:Individual
Prefix:
First Name:ISABELL
Middle Name:
Last Name:BACOT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PETERSON CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4123
Mailing Address - Country:US
Mailing Address - Phone:512-810-2220
Mailing Address - Fax:
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-334-1885
Practice Address - Fax:512-334-1890
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical