Healthcare Provider Details

I. General information

NPI: 1053138289
Provider Name (Legal Business Name): KATHRYN ANN CHAFIZADEH RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E 32ND ST
AUSTIN TX
78705-2703
US

IV. Provider business mailing address

4420 RIVER GARDEN TRL
AUSTIN TX
78746-2016
US

V. Phone/Fax

Practice location:
  • Phone: 512-544-4209
  • Fax:
Mailing address:
  • Phone: 512-750-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number529708
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: