Healthcare Provider Details

I. General information

NPI: 1053821942
Provider Name (Legal Business Name): SHOVA GURUNG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5939 HARRY HINES BLVD 8TH FLOOR RM HQ08 124
DALLAS TX
75390-2628
US

IV. Provider business mailing address

3829 WESTMINSTER DR
CARROLLTON TX
75007-2628
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax:
Mailing address:
  • Phone: 507-469-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP133989
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP133989
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP133989
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: