Active NPI
Nancy Kaa Bristol, PAC MHE BS
- Physician Assistant
- Beaumont, TX
National Provider Identifier
1356396055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2872731206
- Practice address
- 3420 Veterans Cir
Beaumont, TX 77702 - Phone
- (409) 981-8550
- Fax
- (409) 981-8563
- NPI assigned
- May 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2872731206 | UT | Primary |
Addresses
Primary practice location
3420 Veterans Cir
Beaumont, TX 77702
Mailing address
2630 Long St
Beaumont, TX 77702
Phone (409) 981-8550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2872731206 | UT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232409600000",
"number": "1356396055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2630 LONG ST",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "77702",
"telephone_number": "409-981-8550",
"fax_number": "409-981-8563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3420 VETERANS CIR",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "77702",
"telephone_number": "409-981-8550",
"fax_number": "409-981-8563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISTOL",
"first_name": "NANCY",
"middle_name": "KAA",
"name_prefix": "Ms.",
"credential": "PAC MHE BS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-23",
"last_updated": "2009-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "2872731206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
- Brident Dental Associates PC
- Kierra Bridgewater, M.ED., LPC
- Brittany Michelle Briggs
- Brooke Brist
- Bristol Enterprises, Inc (Synergy HomeCare Southeast Texas)
- Meagan Brittain, MS, CCC-SLP
- Brian Mark Broaddus, M.D.
- Jenny Lee Broaddus, LPC-S
- Yolanda Denise Broadnax, CRNP
- Delanea Lynn Bronson, M.S. CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.