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NPI Code Detail

MEDICARE: MRS. SOPA MAHABOONPACHAI APRN/FNP-C

MEDICARE: MRS. SOPA MAHABOONPACHAI APRN/FNP-C
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
1363LF0000XFamily Nurse Practitioner1013544TX

General Provider Information

NPI Number : 1912593252
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SOPA MAHABOONPACHAI APRN/FNP-C
Provider Business Mailing Address
First Line : 4525 PORTRAIT LN
Second Line :
City : PLANO
State : TX
Zip : 75024-3847
Country : US
Telephone Number : 972-212-9431
Fax Number :
Provider Business Practice Location Address
First Line : 7709 SAN JACINTO PL STE 100
Second Line :
City : PLANO
State : TX
Zip : 75024-3369
Country : US
Telephone Number : 972-491-1200
Fax Number : 469-208-4641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2020
Last Update Date : 02/16/2024

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Directions to “ MRS. SOPA MAHABOONPACHAI APRN/FNP-C” Practice Location

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