Li Juan Polvadore

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP133716 Issued in TX

Practice address

305 N Heatherwilde Blvd
Pflugerville, TX 78660-3757

Phone

(877) 637-8387

NPI assigned

Mar 25, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• US Public Health Services

  • Federal Public Health Clinic/Center
  • Houston, TX
  • NPI 1932472453
  NPD (past)

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755302400000",
    "number": "1285194126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 BLUE FOREST DR",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773463245",
            "telephone_number": "405-831-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 N HEATHERWILDE BLVD",
            "city": "PFLUGERVILLE",
            "state": "TX",
            "postal_code": "786603757",
            "telephone_number": "877-637-8387"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15850 Export Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770322545",
            "country_code": "US",
            "telephone_number": "281-985-8511 x58531",
            "fax_number": "281-985-8462",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "23838 Highway 59 N",
            "address_purpose": "LOCATION",
            "city": "Kingwood",
            "state": "TX",
            "postal_code": "773391531",
            "country_code": "US",
            "telephone_number": "832-869-4818",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "902 Frostwood Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770242402",
            "country_code": "US",
            "telephone_number": "832-869-4818",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7877 Willow Chase Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770705934",
            "country_code": "US",
            "telephone_number": "832-869-4818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLVADORE",
        "first_name": "LI JUAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-25",
        "last_updated": "2025-08-16",
        "certification_date": "2025-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP133716",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP133716",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP133716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Planet Smile Dental Centers, PLLC
• PM Management - Pflugerville Al, LLC (Heatherwilde Assisted Living)
• PM Management-Pflugerville NC LLC (Pflugerville Care Center)
• Cassandra Lynne Polanski, PT, DPT
• Howard Polansky, DMD
• Mary-Ellen Pon, LCSW
• Abigail Laura Ponce
• Molly L Pool, MA, SLP-CCC
• Amina Popoola
• Emily Paige Porter

• Nurse Practitioner in Pflugerville, TX
• Providers in Pflugerville, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.