Provider Demographics
NPI:1467946384
Name:MAJESTIC HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:MAJESTIC HEALTHCARE, PLLC
Other - Org Name:ADVANCED MEDICAL SKIN CARE,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:512-364-2151
Mailing Address - Street 1:110 EISENHOWER CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5471
Mailing Address - Country:US
Mailing Address - Phone:512-364-2151
Mailing Address - Fax:
Practice Address - Street 1:110 EISENHOWER CT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633
Practice Address - Country:US
Practice Address - Phone:512-364-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119783363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679719926OtherINSURANCE
TX1679719926OtherINSURANCE
TX1679719926Medicaid