Provider Demographics
NPI:1245944305
Name:BEYIDI NOAH, GABRIELLE ESTELLE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ESTELLE
Last Name:BEYIDI NOAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 JARVIS ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-7404
Mailing Address - Country:US
Mailing Address - Phone:410-300-1665
Mailing Address - Fax:
Practice Address - Street 1:5015 JARVIS ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-7404
Practice Address - Country:US
Practice Address - Phone:410-300-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20220044305363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care