Healthcare Provider Details

I. General information

NPI: 1831630565
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES OF KERRVILLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WESLEY DR
KERRVILLE TX
78028-5809
US

IV. Provider business mailing address

220 WESLEY DR
KERRVILLE TX
78028-5809
US

V. Phone/Fax

Practice location:
  • Phone: 830-896-4711
  • Fax: 830-257-0878
Mailing address:
  • Phone: 830-896-4711
  • Fax: 830-257-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH2802
License Number StateTX

VIII. Authorized Official

Name: DAVID R SPROUSE
Title or Position: PROVIDER/ OWNER
Credential: MD
Phone: 830-896-4711