Provider Demographics
NPI:1366773301
Name:TAYLOR, PRESTON KYLE (CRNA)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:KYLE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 OASIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2713
Mailing Address - Country:US
Mailing Address - Phone:202-321-5925
Mailing Address - Fax:
Practice Address - Street 1:1305 WONDER WORLD DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7546
Practice Address - Country:US
Practice Address - Phone:512-353-8161
Practice Address - Fax:512-353-8255
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX724467163W00000X
TXAP123712367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse