Basic Information
| Provider Information | |||||||||
| NPI: | 1053679019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NATH | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | ROSA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650859 DEPT 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752654021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097728053 | ||||||||
| FaxNumber: | 4097721084 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 HARBORSIDE DR 6TH FLOOR | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775552358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325052450 | ||||||||
| FaxNumber: | 4097470777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2012 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0402X | R9405 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | 207T00000X | R9405 | TX | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.