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NPI Code Detail

MEDICARE: STEPHANIE NICOLE MCGOVERN AGACNP-BC

MEDICARE: STEPHANIE NICOLE MCGOVERN AGACNP-BC
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
1363L00000XNurse PractitionerAP139859TX
2363LA2100XAcute Care Nurse PractitionerAP139859TX

General Provider Information

NPI Number : 1336619709
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE NICOLE MCGOVERN AGACNP-BC
Provider Business Mailing Address
First Line : 112 ADLAI AVE
Second Line :
City : GEORGETOWN
State : TX
Zip : 78633-2686
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1201 W 38TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78705-1006
Country : US
Telephone Number : 512-324-3028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2018
Last Update Date : 04/21/2026

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Directions to “ STEPHANIE NICOLE MCGOVERN AGACNP-BC” Practice Location

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