MEDICARE: KARISA RAE STANCIL FNP-C

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
1	363LF0000X	Family Nurse Practitioner	AP140771	TX

General Provider Information

NPI Number	:	1528529815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISA RAE STANCIL FNP-C

Provider Business Mailing Address
First Line	:	15808 RANCH ROAD 620 N STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-4923
Country	:	US
Telephone Number	:	512-244-3554
Fax Number	:	512-244-2942

Provider Business Practice Location Address
First Line	:	505 W LOUIS HENNA BLVD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-1702
Country	:	US
Telephone Number	:	855-481-8375
Fax Number	:	512-244-2942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	08/15/2023

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