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NPI Code Detail

MEDICARE: MRS. BRISTEN THEVENOT

MEDICARE: MRS. BRISTEN THEVENOT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist205061LA
2367500000XCertified Registered Nurse Anesthetist1217655TX

General Provider Information

NPI Number : 1295563427
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRISTEN THEVENOT
Provider Business Mailing Address
First Line : PO BOX 840853
Second Line :
City : DALLAS
State : TX
Zip : 75284-0853
Country : US
Telephone Number : 972-233-1999
Fax Number : 972-233-3666
Provider Business Practice Location Address
First Line : 1201 W 38TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78705-1006
Country : US
Telephone Number : 512-324-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2024
Last Update Date : 03/05/2026

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Directions to “ MRS. BRISTEN THEVENOT ” Practice Location

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