PEDIAQ TEXAS LLC (NPI# 1326415779) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326415779 |
| Entity Type | Organization |
| Organization Name | PEDIAQ TEXAS LLC |
| Practice Address |
17101 Preston Rd Ste 115 Dallas TX 75248-1331 |
| Practice Telephone | 2149843900 |
| Practice Fax Number | 9722943343 |
| Mailing Telephone | 2149843900 |
| Mailing Fax Number | 9722943343 |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2015-09-01 |
| Authorized Official Name | JON OSULLIVAN (OWNER) |
| Authorized Official Telephone | 21498439000 |
| Is Organization Subpart | Y |
| Parent Organization Name | PEDIAQ LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0222X |
Nurse Practitioner Specialization: Pediatrics, Critical Care |
226944 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
17101 PRESTON RD STE 115 |
| City | DALLAS |
| State | TX |
| Zip Code | 75248-1331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174549406 | Aimee L Wright Do Pa | Family Medicine | 17101 Preston Rd, Suite 200, Dallas, TX 75248-1331 | 2006-07-13 |
| 1477938132 | Pediaq | Nurse Practitioner | 17101 Preston Rd, Ste 115, Dallas, TX 75248-1331 | 2015-07-23 |
| 1992013239 | Jeannette Larue Kilgard | Physician Assistant | 17101 Preston Rd, Suite 200, Dallas, TX 75248-1331 | 2010-09-21 |
| 1033383518 | Keli S. Jones M.d., Pa | Obstetrics & Gynecology | 17101 Preston Rd, Suite 200, Dallas, TX 75248-1331 | 2008-04-16 |
| 1093845349 | Keli Jones | Obstetrics & Gynecology | 17101 Preston Rd, Suite 200, Dallas, TX 75248-1331 | 2007-03-06 |
| 1881616860 | Brandon Marshall Bonds | Chiropractor | 17101 Preston Rd, #190, Dallas, TX 75248 | 2006-07-25 |
| 1053330803 | Kelly L Wimberly | Family Medicine | 17101 Preston Rd, Suite 200, Dallas, TX 75248-1331 | 2006-07-19 |
| 1578589842 | Kelly L Wimberly Md Pa | Family Medicine | 17101 Preston Rd, Suite 200, Dallas, TX 75248-1331 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093336398 | Rachel Carrithers | Registered Nurse | 7611 El Pendsador, Dallas, TX 75248 | 2020-04-28 |
| 1538621024 | Syreeta Williams | Specialist | 16690 Dallas Parkway, Suite 208, Dallas, TX 75248 | 2019-04-03 |
| 1225505928 | Bent Tree Counseling, Pllc | Marriage & Family Therapist | 16800 North Dallas Parkway, Suite 100, Dallas, TX 75248 | 2018-10-31 |
| 1649764598 | Annie Girson | Dentist | 16000 Preston Rd. Suite 310, Dallas, TX 75248 | 2018-06-14 |
| 1821503772 | Affordable Dentist Near Me Dallas Pllc. | Dentist | 14902 Preston Road. Suite 201, Dallas, TX 75248 | 2017-12-13 |
| 1477077717 | Children's Dental At Preston Trail, PC | Dentist | 17194 Preson Road, Dallas, TX 75248 | 2017-07-28 |
| 1871023481 | Caroline Ford | Psychologist | 16150 Preston Road, Dallas, TX 75248 | 2017-06-15 |
| 1679940902 | North Texas Cin, Inc. | Clinic/Center | 15770 North Dallas Parkway, Suite 900, Dallas, TX 75248 | 2015-08-21 |
| 1508246240 | Arzu Shams | Counselor | 17103 Preston Rd Ste 230, Dallas, TX 75248 | 2015-06-08 |
| 1992182174 | Texas Dentistry for Kids Richardson, Pllc | Dentist | 7989 Beltline Rd Ste# 107, Dallas, TX 75248 | 2015-04-27 |
| Find all providers in zip 75248 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598229510 | Sara Klueber | Nurse Practitioner | 1935 Medical District Dr # C8.01, Dallas, TX 75235-7701 | 2019-01-23 |
| 1932671443 | Allison Blazek | Nurse Practitioner | 1935 Medical District Dr # F3.214, Dallas, TX 75235-7701 | 2018-12-21 |
| 1124520291 | Dalia K George | Nurse Practitioner | 7777 Forest Ln Ste C840, Dallas, TX 75230-2594 | 2018-03-06 |
| 1740790849 | Madeline Claire Crank | Nurse Practitioner | 7777 Forest Ln Ste C742, Dallas, TX 75230-6862 | 2017-10-03 |
| 1215480355 | Ashley Smith | Nurse Practitioner | 8325 Walnut Hill Ln# 225, Dallas, TX 75231 | 2016-07-25 |
| 1316349962 | Jennifer Tracy | Nurse Practitioner | 2350 N Stemmons Fwy Ste 4300mcf4, Dallas, TX 75207-2700 | 2014-09-25 |
| 1013334879 | Sneha Patel | Nurse Practitioner | 4830 Cedar Springs Rd, Unit 3, Dallas, TX 75219-1366 | 2014-03-18 |
| 1720415748 | Heidi Nicole Pettit | Nurse Practitioner | 1935 Medical District Dr # E2300, Dallas, TX 75235-7701 | 2013-10-04 |
| 1821357088 | Robyn Joy Haynes | Nurse Practitioner | 1935 Medical District Dr # D2.04, Dallas, TX 75235-7701 | 2012-05-09 |
| 1205102589 | Ashley Caroline Eckstein | Nurse Practitioner | 8440 Walnut Hill Ln Ste 540, Dallas, TX 75231-3824 | 2012-03-30 |
| Find all providers in DALLAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.