Provider Demographics
NPI:1982210571
Name:ROWLANDS, KIM L
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:ROWLANDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 MOUNTAIN PATH CIRCLE
Mailing Address - Street 2:NONE
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-342-2656
Mailing Address - Fax:
Practice Address - Street 1:6101 E OLTORF
Practice Address - Street 2:NONE
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7875
Practice Address - Country:US
Practice Address - Phone:512-437-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01745011OtherDMV