Provider Demographics
NPI:1770083123
Name:THEEL, BILLIE (APRN - NP)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:THEEL
Suffix:
Gender:F
Credentials:APRN - NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 S LAKELINE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4660
Mailing Address - Country:US
Mailing Address - Phone:512-553-1921
Mailing Address - Fax:844-855-3450
Practice Address - Street 1:1905 S LAKELINE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4660
Practice Address - Country:US
Practice Address - Phone:512-553-1921
Practice Address - Fax:844-855-3450
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner