Healthcare Provider Details

I. General information

NPI: 1871453159
Provider Name (Legal Business Name): MADRI PATEL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 FM 1460 UNIT 1602
GEORGETOWN TX
78626-7423
US

IV. Provider business mailing address

2951 FM 1460 UNIT 1602
GEORGETOWN TX
78626-7423
US

V. Phone/Fax

Practice location:
  • Phone: 512-612-9441
  • Fax: 512-650-4420
Mailing address:
  • Phone: 512-612-9441
  • Fax: 512-650-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1003052
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: