Provider Demographics
NPI:1427252352
Name:NYE, MICHAEL SHAWN (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
Last Name:NYE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 HILL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-258-7669
Practice Address - Fax:830-331-8718
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1417372624OtherGROUP NPI
TX354618ZG9WOtherPTAN
TX880N98OtherBCBS
TX206513802Medicaid
TX880N98OtherBCBS