MEDICARE: MRS. GRACE TEMITOPE ROWE APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1191910	TX

General Provider Information

NPI Number	:	1982269536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE TEMITOPE ROWE APRN

Provider Business Mailing Address
First Line	:	5900 BALCONES DR STE 8004
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 BALCONES DR STE 8004
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

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

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	06/08/2026

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