Healthcare Provider Details

I. General information

NPI: 1033864665
Provider Name (Legal Business Name): DEBORAH KATHARINE PRINCE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 BILL PRICE RD
DEL VALLE TX
78617-3630
US

IV. Provider business mailing address

1600 WICKERSHAM LN APT 1085
AUSTIN TX
78741-3132
US

V. Phone/Fax

Practice location:
  • Phone: 512-854-4193
  • Fax:
Mailing address:
  • Phone: 512-619-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1057694
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: