Provider Demographics
NPI:1144924200
Name:PATEL, MOLLY (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8113 THELMA JEAN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4771
Mailing Address - Country:US
Mailing Address - Phone:732-678-7863
Mailing Address - Fax:
Practice Address - Street 1:8113 THELMA JEAN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4771
Practice Address - Country:US
Practice Address - Phone:732-678-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX986208363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner