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General NPI Number Information
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NPI Number | 1881350635
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Entity Type | Individual
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Provider Name | TRIANA MAE SIMS
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Gender | Female
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1500 RED RIVER ST
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City | AUSTIN
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State | TX
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Zip | 78701-1918
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Country | US
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Telephone | 512-324-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 543 GREAT LAWN BND
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City | LIBERTY HILL
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State | TX
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Zip | 78642-2465
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Country | US
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Telephone | 805-766-8885
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15493
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License Number State | TX
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