Basic Information
| Provider Information | |||||||||
| NPI: | 1427088095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LLOYD | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 E RUNDBERG LN | ||||||||
| Address2: | SUITE F | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787534808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128043900 | ||||||||
| FaxNumber: | 5128043901 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 E RUNDBERG LN | ||||||||
| Address2: | SUITE F | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787534808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128043900 | ||||||||
| FaxNumber: | 5128043901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 03/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 6030150 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 0443319 04 | 05 | TX | MEDICAID |