Healthcare Provider Details

I. General information

NPI: 1871896258
Provider Name (Legal Business Name): HEATHER D DONAGHEY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD SUITE 401
AUSTIN TX
78723-3077
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD SUITE 200
AUSTIN TX
78723-3077
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number707475
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: