Healthcare Provider Details

I. General information

NPI: 1326694464
Provider Name (Legal Business Name): KIMBERLY ANDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 DOMAIN BLVD STE 120
AUSTIN TX
78758-3455
US

IV. Provider business mailing address

11801 DOMAIN BLVD STE 120
AUSTIN TX
78758-3455
US

V. Phone/Fax

Practice location:
  • Phone: 512-649-1004
  • Fax: 512-572-5184
Mailing address:
  • Phone: 512-649-1004
  • Fax: 512-572-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13918
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: