Healthcare Provider Details

I. General information

NPI: 1083679419
Provider Name (Legal Business Name): HOLLY R KUBANEY MSN, APRN, PPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD #401
AUSTIN TX
78723-3078
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD SUITE #200
AUSTIN TX
78723-3078
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1900
  • Fax: 512-628-1901
Mailing address:
  • Phone: 512-628-1932
  • Fax: 512-628-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number809189
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: