Healthcare Provider Details

I. General information

NPI: 1942942784
Provider Name (Legal Business Name): KELSEY AMBER LIBURD DNP, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD
AUSTIN TX
78723-3051
US

IV. Provider business mailing address

5121 GOODWIN AVE
DALLAS TX
75206-6204
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number894981
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1073327
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: