Healthcare Provider Details

I. General information

NPI: 1861991580
Provider Name (Legal Business Name): KURT CUELLAR FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TRINITY ST STOP 704
AUSTIN TX
78712-1865
US

IV. Provider business mailing address

1601 TRINITY ST STOP 704
AUSTIN TX
78712-1865
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-7871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136487
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: