Healthcare Provider Details

I. General information

NPI: 1124820980
Provider Name (Legal Business Name): OUTCOMES WOUND THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13915 BURNET RD STE 103
AUSTIN TX
78728-6518
US

IV. Provider business mailing address

13915 BURNET RD STE 103
AUSTIN TX
78728-6518
US

V. Phone/Fax

Practice location:
  • Phone: 512-710-6516
  • Fax: 512-355-1966
Mailing address:
  • Phone: 512-980-0756
  • Fax: 512-980-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CORY PETERSON
Title or Position: OWNER
Credential: PT
Phone: 512-980-0756