Individual provider Active NPI

Abby Nicole Tedlock

  • Acute Care Nurse Practitioner
  • Kyle, TX
National Provider Identifier
1134764962
Registry record updated Nov 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP143980 Issued in TX
Practice address
1180 Seton Pkwy Ste 220
Kyle, TX 78640-6179
Phone
(512) 504-0877
NPI assigned
Nov 15, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP143980 TX Primary

Addresses

Primary practice location

1180 Seton Pkwy Ste 220
Kyle, TX 78640-6179

Mailing address

1180 Seton Pkwy Ste 220
Kyle, TX 78640-6179

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200430000834 TX Practitioner - Nurse Practitioner 6204266422 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Seton Family of DoctorsGroup PAC ID 0941333280, 785 clinicians

Practice addresses (Care Compare)

1400 N Ih 35
Austin, TX 78701-1926

1400 N Ih 35 LL
Cl400 Tri County Prac Assoc
Austin, TX 78701-1926
Phone (512) 324-7300

1500 Red River St
Austin, TX 78701-1918
Phone (512) 324-7000

Hospital & facility affiliations

  • Dell Seton Med Center at the University of TX Hospital, Austin, TX, CCN 450124

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Seton Family of Doctors CurrentSince Apr 1, 2020 Accepting new patients
Seton Family of Doctors CurrentSince Apr 1, 2020 Accepting new patients

Locations

1400 N Interstate 35
Ste 300
Austin, TX 78701
Phone (512) 324-8300

4616 W Howard Ln
Austin, TX 78728
Phone (224) 558-8613

6001 Kyle Pkwy
Kyle, TX 78640
Phone (512) 504-5000

1180 Seton Pkwy
Ste 220
Kyle, TX 78640
Phone (512) 504-0076

Interoperability endpoints

  • Direct secure messaging: abby.tedlock.1@8363.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1134764962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 SETON PKWY STE 220",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 SETON PKWY STE 220",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406179",
            "telephone_number": "512-504-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDLOCK",
        "first_name": "ABBY",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP143980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kyle, TX

Sources for this page

Verify at the official NPI Registry.