Basic Information
Provider Information
NPI: 1912653262
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARDUE
FirstName: ALLISON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN-CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2515 ELMONT DR APT 270
Address2:  
City: AUSTIN
State: TX
PostalCode: 787410055
CountryCode: US
TelephoneNumber: 5127961511
FaxNumber:  
Practice Location
Address1: 901 W BEN WHITE BLVD
Address2:  
City: AUSTIN
State: TX
PostalCode: 787046903
CountryCode: US
TelephoneNumber: 5124472211
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/25/2022
LastUpdateDate: 02/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1070695TXY193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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