Provider Demographics
NPI:1477639847
Name:AUSTIN, NANCY A (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 BRIARPARK DR STE 575
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1031 NEDERLAND AVE
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-2832
Practice Address - Country:US
Practice Address - Phone:281-783-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2022-10-17
Deactivation Date:2018-11-14
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
AZRN 160996163W00000X
AZAP 3365363LF0000X
TXAP105297363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ506105Medicaid