Blue Agave Wound Care Solutions LLC

Primary specialty

Wound Care Registered NurseTaxonomy code 163WW0000X

Legal business name

BLUE AGAVE WOUND CARE SOLUTIONS LLC

Practice address

10109 Lake Creek Pkwy Unit 170434
Austin, TX 78717-0119

Phone

(844) 275-3822

NPI assigned

Nov 5, 2018

Last updated

Nov 5, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Richard Carney

Title

Member LLC

Phone

(619) 568-6800

Specialties & licenses 5

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541376000000",
    "number": "1851869234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 170434",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787170027",
            "telephone_number": "844-275-3822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10109 LAKE CREEK PKWY UNIT 170434",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787170119",
            "telephone_number": "844-275-3822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE AGAVE WOUND CARE SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-05",
        "last_updated": "2018-11-05",
        "status": "A",
        "authorized_official_last_name": "CARNEY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MEMBER LLC",
        "authorized_official_telephone_number": "619-568-6800"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Wound Care Registered Nurse in Austin, TX
• Providers in Austin, TX by specialty
• Wound Care Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.