Healthcare Provider Details

I. General information

NPI: 1275374340
Provider Name (Legal Business Name): JUST A GIRL FROM THE BAYOU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 HICKORY RUN DR
CEDAR PARK TX
78613-3993
US

IV. Provider business mailing address

513 HICKORY RUN DR
CEDAR PARK TX
78613-3993
US

V. Phone/Fax

Practice location:
  • Phone: 512-954-4707
  • Fax:
Mailing address:
  • Phone: 512-705-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: KEESHA L NIX
Title or Position: CEO
Credential: RN, MSN, MHA
Phone: 512-705-0370