Organization
KOTEL ATX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIMENE PEREZ (CREDENTIALING MANAGER)
(904) 750-3344
Entity
Organization
Contact information
Practice address
4201 W PARMER LN STE C175, AUSTIN, TX 78727-4161
(855) 204-2502
Mailing address
3001 BEE CAVES RD STE 220, AUSTIN, TX 78746-5590
(512) 777-2591
(512) 777-3193
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/23/2024
Last updated
12/07/2024
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