Provider Demographics
NPI:1104215383
Name:WARREN, MICHAEL ANTHONY (APRN-CNP, FNP-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:WARREN
Suffix:
Gender:M
Credentials:APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 BABCOCK RD UNIT 251
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4708
Mailing Address - Country:US
Mailing Address - Phone:405-361-7859
Mailing Address - Fax:
Practice Address - Street 1:1603 BABCOCK RD UNIT 251
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4708
Practice Address - Country:US
Practice Address - Phone:405-361-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89877363LF0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200582360AMedicaid
OK405695YNTPMedicare PIN
OK405695YMU8Medicare PIN