Provider Demographics
NPI:1982762332
Name:PRESLEY, RANDY E (MSN)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:E
Last Name:PRESLEY
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 HWY 71 WEST
Mailing Address - Street 2:SUITE F
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735
Mailing Address - Country:US
Mailing Address - Phone:281-412-4434
Mailing Address - Fax:901-322-6083
Practice Address - Street 1:7610 HWY 71 WEST
Practice Address - Street 2:SUITE F
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735
Practice Address - Country:US
Practice Address - Phone:281-412-4434
Practice Address - Fax:901-322-6083
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374195Medicaid
TN4055168OtherBCBS
TN3374195Medicaid
TN3374195Medicare ID - Type Unspecified