Healthcare Provider Details

I. General information

NPI: 1376190082
Provider Name (Legal Business Name): PRISCILLA S HOOKER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRISCILLA S SCHILLING

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PKWY STE 110
LAKEWAY TX
78738-1792
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 512-654-1234
  • Fax:
Mailing address:
  • Phone: 254-724-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT82254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: