Healthcare Provider Details

I. General information

NPI: 1194155689
Provider Name (Legal Business Name): KATE ELIZABETH SMITH PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE ELIZABETH PASKIEWICZ PNP

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W STASSNEY LN STE 110
AUSTIN TX
78745
US

IV. Provider business mailing address

205 E UNIVERSITY AVE SUITE 200
GEORGETOWN TX
78626-6814
US

V. Phone/Fax

Practice location:
  • Phone: 512-954-9320
  • Fax: 512-243-5894
Mailing address:
  • Phone: 877-800-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2316
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: