| NPI | 1730438631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE KENNON Practice Mgr 512-732-2774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2023-07-18 |