Provider Demographics
NPI:1669996443
Name:KRAMER, JACLYN (PMHNP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 W HIGHWAY 290 STE 108
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8827
Mailing Address - Country:US
Mailing Address - Phone:512-430-1130
Mailing Address - Fax:512-677-6806
Practice Address - Street 1:5424 W HIGHWAY 290 STE 108
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8827
Practice Address - Country:US
Practice Address - Phone:512-430-1130
Practice Address - Fax:512-677-6806
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134718363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty