Healthcare Provider Details

I. General information

NPI: 1841816592
Provider Name (Legal Business Name): NATHANIEL NEVITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST STE 700
AUSTIN TX
78705-1016
US

IV. Provider business mailing address

1301 W 38TH ST STE 700
AUSTIN TX
78705-1016
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-3380
  • Fax: 512-324-3379
Mailing address:
  • Phone: 512-324-3380
  • Fax: 512-324-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10071467
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberU3962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: