MEDICARE: PATRICE PATTON BUDD PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	455282	TX

General Provider Information

NPI Number	:	1578659397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE PATTON BUDD PNP

Provider Business Mailing Address
First Line	:	507 OAK PARK DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4091
Country	:	US
Telephone Number	:	512-255-3670
Fax Number	:	512-389-2974

Provider Business Practice Location Address
First Line	:	3311 FM 973 SOUTH
Second Line	:
City	:	DEL VALLE
State	:	TX
Zip	:	78617
Country	:	US
Telephone Number	:	512-386-3335
Fax Number	:	512-389-2974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/09/2007

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