Healthcare Provider Details

I. General information

NPI: 1700491735
Provider Name (Legal Business Name): AUSTIN RUPPANNER MSN, APRN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 MOURNING DOVE LN
LORENA TX
76655-3141
US

IV. Provider business mailing address

2418 W MAIN ST
GUN BARREL CITY TX
75156-3638
US

V. Phone/Fax

Practice location:
  • Phone: 432-770-6626
  • Fax:
Mailing address:
  • Phone: 903-713-2000
  • Fax: 903-713-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1006389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: