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General NPI Number Information
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NPI Number | 1629408463
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Entity Type | Individual
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Provider Name | DENIECE RUSSELL-MCADORY
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Gender | Female
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 6705 W HIGHWAY 290 STE 607
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City | AUSTIN
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State | TX
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Zip | 78735-8408
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Country | US
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Telephone | 512-843-5169
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Fax | 512-856-6238
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Provider Business Mailing Address
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Address Line | 6705 W HIGHWAY 290 STE 607
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City | AUSTIN
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State | TX
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Zip | 78735-8408
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Country | US
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Telephone | 512-843-5169
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Fax | 512-856-6238
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R874534
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1058694
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License Number State | TX
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