Healthcare Provider Details

I. General information

NPI: 1174072235
Provider Name (Legal Business Name): DONNA SUSAN PRATT MSN APRN FNP/C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LIMESTONE TER STE C-3
JARRELL TX
76537-1293
US

IV. Provider business mailing address

769 COUNTY ROAD 4804
COPPERAS COVE TX
76522-6190
US

V. Phone/Fax

Practice location:
  • Phone: 512-588-1501
  • Fax: 512-287-5582
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139734
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: