Healthcare Provider Details

I. General information

NPI: 1396654943
Provider Name (Legal Business Name): AVERY LANE TEMPLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 VIAMONTE LN
SPRING TX
77379-5314
US

IV. Provider business mailing address

17707 VIAMONTE LN
SPRING TX
77379-5314
US

V. Phone/Fax

Practice location:
  • Phone: 832-208-6414
  • Fax:
Mailing address:
  • Phone: 832-208-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09260103
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: