1013380963 NPI number — DEEPIKA THANKANCHAN APRN

Table of content: DEEPIKA THANKANCHAN APRN (NPI 1013380963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013380963 NPI number — DEEPIKA THANKANCHAN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THANKANCHAN
Provider First Name:
DEEPIKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013380963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 CROSS TIMBERS RD STE 1250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-8824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-488-0121
Provider Business Mailing Address Fax Number:
972-459-2656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 CROSS TIMBERS RD STE 1250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-8824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-488-0121
Provider Business Practice Location Address Fax Number:
972-459-2656
Provider Enumeration Date:
10/31/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP129502 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)