Healthcare Provider Details

I. General information

NPI: 1134084874
Provider Name (Legal Business Name): TAYLOR DANE HUDNALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 ROGERS RD APT 9308
SAN ANTONIO TX
78251-3797
US

IV. Provider business mailing address

5219 ROGERS RD APT 9308
SAN ANTONIO TX
78251-3797
US

V. Phone/Fax

Practice location:
  • Phone: 210-556-2096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1201954
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: