Provider Demographics
NPI:1588232342
Name:KIMPAN, RACHAEL MARY (FNP-C)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARY
Last Name:KIMPAN
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 VARGAS RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3557
Mailing Address - Country:US
Mailing Address - Phone:512-844-1889
Mailing Address - Fax:
Practice Address - Street 1:1106 CLAYTON LN STE 102W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2433
Practice Address - Country:US
Practice Address - Phone:512-872-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily