Basic Information
| Provider Information | |||||||||
| NPI: | 1619561834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASCOLA | ||||||||
| FirstName: | KRYSTOL | ||||||||
| MiddleName: | RAYE | ||||||||
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| Credential: | CNP WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 W 34TH ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7372795781 | ||||||||
| FaxNumber: | 7372795953 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 W 34TH ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7372795781 | ||||||||
| FaxNumber: | 7372795953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2021 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 921997 | TX | N | Nursing Service Providers | Registered Nurse | General Practice | 363LW0102X | 1074351 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.