Provider Demographics
NPI:1801551817
Name:GALVAN, EMMY JO (FNP-C)
Entity type:Individual
Prefix:
First Name:EMMY
Middle Name:JO
Last Name:GALVAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:EMMY
Other - Middle Name:JO
Other - Last Name:BRACEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:
Practice Address - Street 1:622 W STATE HIGHWAY 71 STE 102
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4286
Practice Address - Country:US
Practice Address - Phone:512-308-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily