Provider Demographics
NPI:1356423842
Name:FAGNER, KARIN S (NP)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:S
Last Name:FAGNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500174
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-0174
Mailing Address - Country:US
Mailing Address - Phone:512-250-9140
Mailing Address - Fax:512-250-2207
Practice Address - Street 1:3500 LOHMANS FORD RD
Practice Address - Street 2:UNIT 25
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-8031
Practice Address - Country:US
Practice Address - Phone:512-917-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644886363LA2200X
TXAP108390363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088304304Medicaid
TXS42184Medicare UPIN
TX088304304Medicaid