Healthcare Provider Details

I. General information

NPI: 1134634678
Provider Name (Legal Business Name): MANINDER KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W RANDOL MILL RD
ARLINGTON TX
76011-5857
US

IV. Provider business mailing address

756 E LAKE DR
COPPELL TX
75019-7906
US

V. Phone/Fax

Practice location:
  • Phone: 817-987-1805
  • Fax:
Mailing address:
  • Phone: 972-807-3600
  • Fax: 972-807-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP135418
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP135418
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: