MEDICARE: SREEKALA ASHOKKUMAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	199873	TX

General Provider Information

NPI Number	:	1609325687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SREEKALA ASHOKKUMAR

Provider Business Mailing Address
First Line	:	1875 POLO HEIGHTS DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-0428
Country	:	US
Telephone Number	:	214-218-0218
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 S LANCASTER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-7167
Country	:	US
Telephone Number	:	214-742-8387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2016
Last Update Date	:	10/01/2016

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