Healthcare Provider Details

I. General information

NPI: 1790412864
Provider Name (Legal Business Name): KRISTEN GABBARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 BEE CAVES RD
AUSTIN TX
78746-4720
US

IV. Provider business mailing address

809 S LAMAR BLVD APT 147
AUSTIN TX
78704-1562
US

V. Phone/Fax

Practice location:
  • Phone: 512-328-3376
  • Fax:
Mailing address:
  • Phone: 772-532-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1089250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: