Healthcare Provider Details

I. General information

NPI: 1073270914
Provider Name (Legal Business Name): RON MCCALL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W 45TH ST
AUSTIN TX
78751-3014
US

IV. Provider business mailing address

408 W 45TH ST
AUSTIN TX
78751-3014
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-5800
  • Fax:
Mailing address:
  • Phone: 512-968-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1059488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: