Healthcare Provider Details

I. General information

NPI: 1407548357
Provider Name (Legal Business Name): LEANNE MARIE COWLES AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4681 COLLEGE PARK DR
ROUND ROCK TX
78665-1526
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1112232
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: