Individual provider · NPI-1

Ayesha Bacchus

Nurse Practitioner, Pediatrics · Round Rock, TX

NPI number1477265759
StatusActive
Last updated in NPPESMay 3, 2024

Details

NPI
1477265759
Entity type
Individual (NPI-1)
Name
Ayesha Bacchus
Sex
Female
Sole proprietor
Yes
Enumeration date
Dec 19, 2022
Certification date
May 3, 2024
Last updated
May 3, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, Pediatrics1102199TXYes

Practice location

16040 Park Valley Dr Ste 227
Round Rock, TX 78681-3596

Phone 512-255-7337

Mailing address

16040 Park Valley Dr Ste 227
Round Rock, TX 78681-3596

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