Healthcare Provider Details

I. General information

NPI: 1407190572
Provider Name (Legal Business Name): KRISTIN MARIE SCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST MEDICAL PARK TOWER SUITE 514
AUSTIN TX
78705
US

IV. Provider business mailing address

1301 W 38TH ST STE 400
AUSTIN TX
78705-1017
US

V. Phone/Fax

Practice location:
  • Phone: 512-681-0500
  • Fax: 512-681-0501
Mailing address:
  • Phone: 512-324-3440
  • Fax: 512-406-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22498
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.009780
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP124094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: