Basic Information
| Provider Information | |||||||||
| NPI: | 1336319599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSBOOM | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | HAMBLEN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13830 SAWYER RANCH RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | DRIPPING SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786205514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123016400 | ||||||||
| FaxNumber: | 5123016401 | ||||||||
| Practice Location | |||||||||
| Address1: | 3944 RR 620 S STE 102 | ||||||||
| Address2: | |||||||||
| City: | BEE CAVE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787387178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127770884 | ||||||||
| FaxNumber: | 5127770933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2008 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA02586 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.