Provider Demographics
NPI:1487111688
Name:CHITALE, KAVITA A (FNP)
Entity type:Individual
Prefix:
First Name:KAVITA
Middle Name:A
Last Name:CHITALE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 N LAMAR BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5976
Mailing Address - Country:US
Mailing Address - Phone:512-387-8208
Mailing Address - Fax:512-782-9316
Practice Address - Street 1:906 W MCDERMOTT DR STE A-124
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6510
Practice Address - Country:US
Practice Address - Phone:469-564-1026
Practice Address - Fax:512-782-9316
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121566363L00000X
TXAP140662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty