Healthcare Provider Details

I. General information

NPI: 1164249223
Provider Name (Legal Business Name): RAGAN ANDREA MORTON KING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 WYOMING SPRINGS DR STE 600
ROUND ROCK TX
78681-4305
US

IV. Provider business mailing address

3300 WELLS BRANCH PKWY APT 12308
AUSTIN TX
78728-6732
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-1995
  • Fax:
Mailing address:
  • Phone: 713-206-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: