Provider Demographics
NPI:1083679419
Name:KUBANEY, HOLLY R (MSN, APRN, PPCNP-BC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:R
Last Name:KUBANEY
Suffix:
Gender:F
Credentials:MSN, APRN, PPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3078
Mailing Address - Country:US
Mailing Address - Phone:512-628-1932
Mailing Address - Fax:512-628-1801
Practice Address - Street 1:1301 BARBARA JORDAN BLVD
Practice Address - Street 2:#401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3078
Practice Address - Country:US
Practice Address - Phone:512-628-1900
Practice Address - Fax:512-628-1901
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX809189363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX809189OtherTX APN
TX301347601Medicaid
TXTXB154990Medicare PIN