Provider Demographics
NPI:1467424945
Name:MACHUGA, KATHRYN SMITH (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SMITH
Last Name:MACHUGA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 JAMES CASEY ST
Mailing Address - Street 2:STE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3300
Mailing Address - Country:US
Mailing Address - Phone:512-445-5998
Mailing Address - Fax:512-445-6095
Practice Address - Street 1:4207 JAMES CASEY ST
Practice Address - Street 2:STE 215
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3300
Practice Address - Country:US
Practice Address - Phone:512-445-5998
Practice Address - Fax:512-445-6095
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX459561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1747180-01Medicaid
TX8D5523Medicare ID - Type Unspecified