Provider Demographics
NPI:1740087212
Name:PETRICONE, WILLIAM R III (RN)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:PETRICONE
Suffix:III
Gender:M
Credentials:RN
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Mailing Address - Street 1:101 W LOUIS HENNA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-1203
Mailing Address - Country:US
Mailing Address - Phone:512-244-4272
Mailing Address - Fax:512-244-2895
Practice Address - Street 1:3418 N LAMAR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1176
Practice Address - Country:US
Practice Address - Phone:512-244-4272
Practice Address - Fax:512-244-2895
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-09-16
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Provider Licenses
StateLicense IDTaxonomies
TX1123512163W00000X, 364S00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program