Provider Demographics
NPI:1992553549
Name:HALLER, DUSTIN DURAND (MSN, AG-ACNP)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:DURAND
Last Name:HALLER
Suffix:
Gender:M
Credentials:MSN, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 AMBER BREEZE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2932
Mailing Address - Country:US
Mailing Address - Phone:806-543-0868
Mailing Address - Fax:
Practice Address - Street 1:6800 W IH 10 STE 350
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2044
Practice Address - Country:US
Practice Address - Phone:210-692-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX850505163WC0200X
TX1153885363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care