1750071908 NPI number — NISHA MARY GEORGE RN, APRN, AGACNP

Table of content: DR. SKYE V PAYNE PH.D. (NPI 1548324924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750071908 NPI number — NISHA MARY GEORGE RN, APRN, AGACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
NISHA
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, APRN, AGACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POULOSE
Provider Other First Name:
NISHA
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750071908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75235-0629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-424-2200
Provider Business Mailing Address Fax Number:
214-231-2159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
981 STATE HIGHWAY 121 STE 1140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75013-6148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-697-5100
Provider Business Practice Location Address Fax Number:
469-697-5105
Provider Enumeration Date:
05/11/2023

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: 363LA2100X , with the licence number:  1098461 , 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)





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