Healthcare Provider Details

I. General information

NPI: 1902301435
Provider Name (Legal Business Name): JOBY T THANKAPPAN RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOBY T THANKAPPAN JOBY THANKAPPAN

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE
DALLAS TX
75203-1201
US

IV. Provider business mailing address

559 E OVILLA RD
RED OAK TX
75154-3505
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-5000
  • Fax: 214-947-5040
Mailing address:
  • Phone: 855-955-2256
  • Fax: 817-533-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136333
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: