=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124941273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BASTROP COUNTY PUBLIC HEALTH DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2026
-----------------------------------------------------
Last Update Date | 08/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 LOOP 150 W STE 102
-----------------------------------------------------
City | BASTROP
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78602-4065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-581-4237
-----------------------------------------------------
Fax | 512-581-4205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 PECAN ST
-----------------------------------------------------
City | BASTROP
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78602-3818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-581-4237
-----------------------------------------------------
Fax | 512-581-4205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. DONNA NICHOLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-581-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------