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General NPI Number Information
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NPI Number | 1962226092
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Entity Type | Individual
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Provider Name | TAELOR MCKENZIE DEIKE FNP
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Gender | Female
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 2200 N A W GRIMES BLVD STE 210
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City | ROUND ROCK
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State | TX
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Zip | 78665-2424
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Country | US
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Telephone | 512-772-2929
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Fax |
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Provider Business Mailing Address
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Address Line | 11000 BLOSSOM BELL DR
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City | AUSTIN
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State | TX
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Zip | 78758-4215
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Country | US
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Telephone | 512-730-9455
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1178699
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License Number State | TX
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