Healthcare Provider Details

I. General information

NPI: 1891154605
Provider Name (Legal Business Name): TRAVIS CO SHERRIFF DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 BILL PRICE RD
DEL VALLE TX
78617-3630
US

IV. Provider business mailing address

141 RED OAK ST
SEGUIN TX
78155-7411
US

V. Phone/Fax

Practice location:
  • Phone: 512-854-4193
  • Fax:
Mailing address:
  • Phone: 830-305-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241387
License Number StateTX

VIII. Authorized Official

Name: MS. KATHRYN T SMITH
Title or Position: FNP
Credential: FNP
Phone: 512-854-4193