Provider Demographics
NPI:1962226092
Name:DEIKE, TAELOR MCKENZIE (FNP)
Entity type:Individual
Prefix:MISS
First Name:TAELOR
Middle Name:MCKENZIE
Last Name:DEIKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 BLOSSOM BELL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4215
Mailing Address - Country:US
Mailing Address - Phone:512-730-9455
Mailing Address - Fax:
Practice Address - Street 1:2200 N A W GRIMES BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2424
Practice Address - Country:US
Practice Address - Phone:512-772-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily