Individual
KYRSTEN JAQUELYN WITHEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NONE
Contact information
Practice address
111 W ANDERSON LN # D202B, AUSTIN, TX 78752-1132
(512) 493-9755
(866) 242-3803
Mailing address
111 W ANDERSON LN # D202B, AUSTIN, TX 78752-1132
(512) 493-9755
(866) 242-3803
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790146942
—
TX
Enumeration date
07/08/2019
Last updated
07/08/2019
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