Healthcare Provider Details

I. General information

NPI: 1215856109
Provider Name (Legal Business Name): HEATHER O'DANIEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 GUADALUPE ST STE 100
AUSTIN TX
78705-2858
US

IV. Provider business mailing address

3110 GUADALUPE ST STE 100
AUSTIN TX
78705-2858
US

V. Phone/Fax

Practice location:
  • Phone: 512-675-1359
  • Fax:
Mailing address:
  • Phone: 512-675-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: