Healthcare Provider Details

I. General information

NPI: 1578659397
Provider Name (Legal Business Name): PATRICE PATTON BUDD PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 FM 973 SOUTH
DEL VALLE TX
78617
US

IV. Provider business mailing address

507 OAK PARK DR
ROUND ROCK TX
78681-4091
US

V. Phone/Fax

Practice location:
  • Phone: 512-386-3335
  • Fax: 512-389-2974
Mailing address:
  • Phone: 512-255-3670
  • Fax: 512-389-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number455282
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: