Provider Demographics
NPI:1821754581
Name:WORKMAN, MARY RACHEL (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RACHEL
Last Name:WORKMAN
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 1:15207 BACK OF THE MOON ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-1703
Mailing Address - Country:US
Mailing Address - Phone:512-221-8940
Mailing Address - Fax:
Practice Address - Street 1:911 W 38TH ST STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1107
Practice Address - Country:US
Practice Address - Phone:512-459-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2021097597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily