Healthcare Provider Details

I. General information

NPI: 1144594557
Provider Name (Legal Business Name): CINDY LEA VARNUM AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 FM 620 N
AUSTIN TX
78717-1126
US

IV. Provider business mailing address

1619 E COMMON ST STE 601602
NEW BRAUNFELS TX
78130-3452
US

V. Phone/Fax

Practice location:
  • Phone: 737-236-6400
  • Fax:
Mailing address:
  • Phone: 806-712-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number77720
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number77720
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number77720
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number77720
License Number StateWV
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP145263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: