Healthcare Provider Details

I. General information

NPI: 1891152948
Provider Name (Legal Business Name): CHRISTINE KOESTEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 03/25/2019
Certification Date:
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: