Healthcare Provider Details

I. General information

NPI: 1508377615
Provider Name (Legal Business Name): AMY KRAIZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 10/23/2021
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 AIRPORT BLVD
AUSTIN TX
78702-3152
US

IV. Provider business mailing address

1165 AIRPORT BLVD
AUSTIN TX
78702-3152
US

V. Phone/Fax

Practice location:
  • Phone: 512-703-1365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number965435
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: