Provider Demographics
NPI:1164249223
Name:KING, RAGAN ANDREA MORTON (PA-C)
Entity type:Individual
Prefix:
First Name:RAGAN
Middle Name:ANDREA MORTON
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3300 WELLS BRANCH PKWY APT 12308
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6732
Mailing Address - Country:US
Mailing Address - Phone:713-206-6644
Mailing Address - Fax:
Practice Address - Street 1:7200 WYOMING SPRINGS DR STE 600
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4305
Practice Address - Country:US
Practice Address - Phone:512-244-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant