Provider Demographics
NPI:1669102133
Name:MOLDER, JAMIE (NNP-BC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MOLDER
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N IH 35 STE 770
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1853
Mailing Address - Country:US
Mailing Address - Phone:512-482-8880
Mailing Address - Fax:512-482-8862
Practice Address - Street 1:3000 N IH 35 STE 770
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1853
Practice Address - Country:US
Practice Address - Phone:512-482-8880
Practice Address - Fax:512-482-8862
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1279736163WN0002X
VA0024185193363LN0005X
TX1123554363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care