Healthcare Provider Details

I. General information

NPI: 1174295455
Provider Name (Legal Business Name): TAYLOR PREDDY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E HIGHLAND MALL BLVD STE 305
AUSTIN TX
78752-3731
US

IV. Provider business mailing address

2003 BUTTERNUT RD
TEMPLE TX
76502-7465
US

V. Phone/Fax

Practice location:
  • Phone: 512-807-0640
  • Fax:
Mailing address:
  • Phone: 713-582-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1168161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: