Healthcare Provider Details

I. General information

NPI: 1508485434
Provider Name (Legal Business Name): DEEPA P KARUNAKARAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 OLD AUSTIN HWY
BASTROP TX
78602-5168
US

IV. Provider business mailing address

4495 WANDERING VINE TRL
ROUND ROCK TX
78665-1266
US

V. Phone/Fax

Practice location:
  • Phone: 512-321-3527
  • Fax:
Mailing address:
  • Phone: 512-840-1158
  • Fax: 512-777-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP144564
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: