MEDICARE: BLUE AGAVE FUNCTIONAL MEDICINE BULVERDE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1215888573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE AGAVE FUNCTIONAL MEDICINE BULVERDE PLLC

Provider Business Mailing Address
First Line	:	3321 WHITT PARK PATH
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-3975
Country	:	US
Telephone Number	:	512-293-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	20475 HIGHWAY 46 W STE 350
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6147
Country	:	US
Telephone Number	:	512-293-9800
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SCOTT PATRICK KNEPPER
Credential	:	KNEPPER
Telephone Number	:	512-293-9800

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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