Organization
AUSTIN CHILDREN'S SHELTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY FYE (DEPUTY DIRECTOR OF FINANCE)
(512) 499-0090
Entity
Organization
Contact information
Practice address
1501 ENFIELD RD, AUSTIN, TX 78703
(512) 499-0090
(512) 499-0438
Mailing address
804 RIO GRANDE ST STE C, AUSTIN, TX 78701-2201
(512) 499-0090
(512) 499-0438
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
596183
TX
Other
Enumeration date
11/28/2007
Last updated
11/28/2007
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