Provider Demographics
NPI:1184252025
Name:MAAG, MISTI BROWN
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:BROWN
Last Name:MAAG
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 1:2206 CHEYENNE PASS
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-6072
Mailing Address - Country:US
Mailing Address - Phone:512-508-1482
Mailing Address - Fax:
Practice Address - Street 1:1 CHISHOLM TRAIL RD STE 5100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5090
Practice Address - Country:US
Practice Address - Phone:512-273-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX714936163W00000X
TXAP145839363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX714936OtherTEXAS BOARD OF NURSING
TXAP145839OtherTEXAS BOARD OF NURSING