Provider Demographics
NPI:1568125862
Name:RIEDEL, KARINA (PMHNP)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:
Other - Last Name:GADRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:4005 BANISTER LN STE 200C
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8077
Mailing Address - Country:US
Mailing Address - Phone:512-328-7222
Mailing Address - Fax:
Practice Address - Street 1:4005 BANISTER LN STE 200C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8077
Practice Address - Country:US
Practice Address - Phone:781-985-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046642363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health