=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861156127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE KRISTINE THIELKE APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2021
-----------------------------------------------------
Last Update Date | 10/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8402 CROSS PARK DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78754-4595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-823-0570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 HALEYS CV
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78641-9445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-567-7828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1048232
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------