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General NPI Number Information
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NPI Number | 1740087212
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Entity Type | Individual
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Provider Name | WILLIAM R PETRICONE III RN
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Gender | Male
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 3418 N LAMAR BLVD STE 100
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City | AUSTIN
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State | TX
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Zip | 78705-1176
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Country | US
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Telephone | 512-244-4272
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Fax | 512-244-2895
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Provider Business Mailing Address
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Address Line | 101 W LOUIS HENNA BLVD STE 300
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City | AUSTIN
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State | TX
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Zip | 78728-1203
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Country | US
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Telephone | 512-244-4272
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Fax | 512-244-2895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1123512
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 1123512
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 1123512
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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