1083679419 NPI number — HOLLY R KUBANEY MSN, APRN, PPCNP-BC

Table of content: HOLLY R KUBANEY MSN, APRN, PPCNP-BC (NPI 1083679419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083679419 NPI number — HOLLY R KUBANEY MSN, APRN, PPCNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUBANEY
Provider First Name:
HOLLY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, PPCNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083679419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 BARBARA JORDAN BLVD
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78723-3078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-628-1932
Provider Business Mailing Address Fax Number:
512-628-1801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 BARBARA JORDAN BLVD
Provider Second Line Business Practice Location Address:
#401
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78723-3078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-628-1900
Provider Business Practice Location Address Fax Number:
512-628-1901
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  809189 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 809189 . This is a "TX APN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 301347601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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