Healthcare Provider Details

I. General information

NPI: 1518460930
Provider Name (Legal Business Name): AMITA AGHERA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 WANDERING VINE TRL
ROUND ROCK TX
78665-1266
US

IV. Provider business mailing address

4495 WANDERING VINE TRL
ROUND ROCK TX
78665-1266
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136700
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: