OrganizationActive
Pediaq Texas LLC
NPI 1326415779 · Pediatric Nurse Practitioner · Dallas, TX
Provider details
- NPI number
- 1326415779
- Entity type
- Organization
- Primary specialty
- Pediatric Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Parent organization
- Pediaq LLC
- Organization subpart
- Yes
- Authorized official
- Jon Osullivan, Owner21498439000
- License
- 226944 (TX)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Established profile(73/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
17101 Preston Rd
Ste 115
Dallas, TX 75248-1331
Phone: (214) 984-3900
Fax: (972) 294-3343
Street-level locationGet directions
Mailing address
17101 Preston Rd
Dallas, TX 75248-1331
Registry dates
- Enumerated
- 2015-09-01
- Last updated
- 2015-09-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.