Healthcare Provider Details

I. General information

NPI: 1851051700
Provider Name (Legal Business Name): KIMBERLY JAGST AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 06/02/2023
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 38TH ST STE 200
AUSTIN TX
78731-6405
US

IV. Provider business mailing address

1600 W 38TH ST STE 200
AUSTIN TX
78731-6405
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-3540
  • Fax: 512-324-3541
Mailing address:
  • Phone: 512-324-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number830762
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1085924
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLP-0010497
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberLP-0010497
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberLP-0010497
License Number StateDE
# 6
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1085924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: