Provider Demographics
NPI:1003289265
Name:PAGANONI, CAROLINE BYRD (CNM-APRN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BYRD
Last Name:PAGANONI
Suffix:
Gender:F
Credentials:CNM-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 FORTVIEW RD.
Mailing Address - Street 2:ATTN: CAROLINE PAGANONI
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:713-419-8223
Mailing Address - Fax:
Practice Address - Street 1:1711 FORTVIEW RD.
Practice Address - Street 2:ATTN: CAROLINE PAGANONI
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:713-419-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCNM2822367A00000X
TXAP129611367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty