Healthcare Provider Details

I. General information

NPI: 1457128951
Provider Name (Legal Business Name): JUDITH RAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 STATE HIGHWAY 121 STE 1140
ALLEN TX
75013-6148
US

IV. Provider business mailing address

PO BOX 35629
DALLAS TX
75235-0629
US

V. Phone/Fax

Practice location:
  • Phone: 469-697-5100
  • Fax:
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11230432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: