Healthcare Provider Details

I. General information

NPI: 1336259308
Provider Name (Legal Business Name): KELLY S GETTIG MSN, APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD STE 307
AUSTIN TX
78723-3080
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-9999
  • Fax:
Mailing address:
  • Phone: 512-324-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number649898
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: