Healthcare Provider Details

I. General information

NPI: 1467424945
Provider Name (Legal Business Name): KATHRYN SMITH MACHUGA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 JAMES CASEY ST STE 215
AUSTIN TX
78745-3300
US

IV. Provider business mailing address

4207 JAMES CASEY ST STE 215
AUSTIN TX
78745-3300
US

V. Phone/Fax

Practice location:
  • Phone: 512-445-5998
  • Fax: 512-445-6095
Mailing address:
  • Phone: 512-445-5998
  • Fax: 512-445-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number459561
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: