Provider Demographics
NPI:1073890976
Name:KANGOS, LINDA JEANNE (RN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEANNE
Last Name:KANGOS
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 HYMEADOW DR STE 3F
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1829
Mailing Address - Country:US
Mailing Address - Phone:512-250-1997
Mailing Address - Fax:512-250-1529
Practice Address - Street 1:12411 HYMEADOW DR STE 3F
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1829
Practice Address - Country:US
Practice Address - Phone:512-250-1997
Practice Address - Fax:512-250-1529
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX459658363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics