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NPI Code Detail

MEDICARE: ASHLYN ARCHER FREDERIKSEN PA-C

MEDICARE: ASHLYN ARCHER FREDERIKSEN PA-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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantPA16175TX
3207Q00000XFamily Medicine PhysicianPA16175TX

General Provider Information

NPI Number : 1992317176
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLYN ARCHER FREDERIKSEN PA-C
Provider Business Mailing Address
First Line : 6210 E HWY 290
Second Line :
City : AUSTIN
State : TX
Zip : 78723-1098
Country : US
Telephone Number : 512-483-9596
Fax Number : 512-406-7621
Provider Business Practice Location Address
First Line : 11714 WILSON PARKE AVE STE 150
Second Line :
City : AUSTIN
State : TX
Zip : 78726-4061
Country : US
Telephone Number : 737-247-7200
Fax Number : 512-406-7368
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2020
Last Update Date : 06/12/2026

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Directions to “ ASHLYN ARCHER FREDERIKSEN PA-C” Practice Location

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