Healthcare Provider Details

I. General information

NPI: 1316609639
Provider Name (Legal Business Name): YAGYA BIMALI APRN AGCNS-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 WANDERING VINE TRL
ROUND ROCK TX
78665-1266
US

IV. Provider business mailing address

575 VENDEMMIA BND
AUSTIN TX
78738-1166
US

V. Phone/Fax

Practice location:
  • Phone: 512-840-1158
  • Fax:
Mailing address:
  • Phone: 512-777-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1056947
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number1056947
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: