Healthcare Provider Details

I. General information

NPI: 1417949041
Provider Name (Legal Business Name): KIMBERLY ANISE POWERS RN, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANISE GALLEGOS CNS

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W 38TH ST
AUSTIN TX
78705-1006
US

IV. Provider business mailing address

1707 CORAL DR
CEDAR PARK TX
78613-3542
US

V. Phone/Fax

Practice location:
  • Phone: 512-681-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP111182
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number278405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: