Healthcare Provider Details

I. General information

NPI: 1356423842
Provider Name (Legal Business Name): KARIN S FAGNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 LOHMANS FORD RD UNIT 25
LAGO VISTA TX
78645-8031
US

IV. Provider business mailing address

PO BOX 500174
AUSTIN TX
78750-0174
US

V. Phone/Fax

Practice location:
  • Phone: 512-917-1109
  • Fax:
Mailing address:
  • Phone: 512-250-9140
  • Fax: 512-250-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number644886
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP108390
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: