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General NPI Number Information
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NPI Number | 1255740098
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Entity Type | Individual
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Provider Name | RYAN CARPENTER
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Gender | Male
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 12/23/2016
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Provider Practice Location Address
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Address Line | 1108 LAVACA ST STE 110-320
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City | AUSTIN
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State | TX
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Zip | 78701-2172
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Country | US
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Telephone | 512-477-4088
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Fax | 512-482-0390
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Provider Business Mailing Address
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Address Line | 7620 DEER RUN
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City | VOLENTE
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State | TX
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Zip | 78641-6108
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Country | US
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Telephone | 512-351-1035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | AP125878
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License Number State | TX
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