Healthcare Provider Details

I. General information

NPI: 1912529686
Provider Name (Legal Business Name): PARISA PAKRAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W RANDOL MILL RD
ARLINGTON TX
76011-5857
US

IV. Provider business mailing address

201 W RANDOL MILL RD
ARLINGTON TX
76011-5857
US

V. Phone/Fax

Practice location:
  • Phone: 817-987-1805
  • Fax:
Mailing address:
  • Phone: 817-987-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number989518
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1129667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: