Provider Demographics
NPI:1700491735
Name:RUPPANNER, AUSTIN (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:RUPPANNER
Suffix:
Gender:M
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-3638
Mailing Address - Country:US
Mailing Address - Phone:903-713-2000
Mailing Address - Fax:903-713-2004
Practice Address - Street 1:2205 MOURNING DOVE LN
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655-3141
Practice Address - Country:US
Practice Address - Phone:432-770-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily