Healthcare Provider Details

I. General information

NPI: 1154254365
Provider Name (Legal Business Name): ALLISON MARY WOLF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12174 N MOPAC EXPY STE A
AUSTIN TX
78758-2910
US

IV. Provider business mailing address

PO BOX 736403
DALLAS TX
75373-6403
US

V. Phone/Fax

Practice location:
  • Phone: 303-535-7548
  • Fax:
Mailing address:
  • Phone: 303-535-7548
  • Fax: 888-504-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24566444
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: