Healthcare Provider Details

I. General information

NPI: 1275978306
Provider Name (Legal Business Name): GREATER AUSTIN ALLERGY, ASTHMA & IMMUNOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E MAIN ST
ROUND ROCK TX
78664-5246
US

IV. Provider business mailing address

303 E MAIN ST
ROUND ROCK TX
78664-5246
US

V. Phone/Fax

Practice location:
  • Phone: 512-732-2774
  • Fax: 855-959-1863
Mailing address:
  • Phone: 512-732-2774
  • Fax: 855-959-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. CANDICE KENNON
Title or Position: PRACTICE MGR
Credential:
Phone: 512-732-2774