Provider Demographics
NPI:1205457728
Name:MCCRARY, KATIE (FNP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MCCRARY
Suffix:
Gender:F
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 1:1033 LA POSADA DR STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3830
Mailing Address - Country:US
Mailing Address - Phone:512-391-9700
Mailing Address - Fax:512-391-9703
Practice Address - Street 1:1033 LA POSADA DR STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3830
Practice Address - Country:US
Practice Address - Phone:512-391-9700
Practice Address - Fax:512-391-9703
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1588853618OtherGROUP NPI