Healthcare Provider Details

I. General information

NPI: 1235930827
Provider Name (Legal Business Name): SHARLENE KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WESTINGHOUSE RD UNIT 100
GEORGETOWN TX
78626-3417
US

IV. Provider business mailing address

701 E FM 1626 STE 204
AUSTIN TX
78748-2892
US

V. Phone/Fax

Practice location:
  • Phone: 512-478-2273
  • Fax: 512-472-0921
Mailing address:
  • Phone: 512-478-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: