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General NPI Number Information
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NPI Number | 1275978306
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Entity Type | Organization
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Legal Business Name | GREATER AUSTIN ALLERGY, ASTHMA & IMMUNOLOGY PA
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 303 E MAIN ST
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City | ROUND ROCK
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State | TX
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Zip | 78664-5246
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Country | US
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Telephone | 512-732-2774
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Fax | 855-959-1863
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Provider Business Mailing Address
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Address Line | 303 E MAIN ST
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City | ROUND ROCK
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State | TX
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Zip | 78664-5246
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Country | US
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Telephone | 512-732-2774
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Fax | 855-959-1863
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Authorized Official
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Title or Position | PRACTICE MGR
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Name | MS. CANDICE KENNON
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Credential |
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Telephone | 512-732-2774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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