Healthcare Provider Details

I. General information

NPI: 1811475809
Provider Name (Legal Business Name): MINDY DAWN COAKLEY AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINDY DAWN BRAINARD RN

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JACKSON AVE
AUSTIN TX
78731-6056
US

IV. Provider business mailing address

2203A LANIER DR
AUSTIN TX
78757-7738
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-4711
  • Fax:
Mailing address:
  • Phone: 512-560-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number756883
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number756883
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP144899
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP144899
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP144899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: