Healthcare Provider Details

I. General information

NPI: 1639625965
Provider Name (Legal Business Name): CARMEN E. ADDINGTON CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 N MOPAC EXPY BLDG 3, STE 200
AUSTIN TX
78731
US

IV. Provider business mailing address

6500 N MOPAC EXPY BLDG 3, STE 200
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-8400
  • Fax: 512-458-8593
Mailing address:
  • Phone: 512-458-8400
  • Fax: 512-458-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number763846
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131244
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: