Healthcare Provider Details

I. General information

NPI: 1013473248
Provider Name (Legal Business Name): NONGNUCH KULIGOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W UNIVERSITY DR STE 150
DENTON TX
76201-0029
US

IV. Provider business mailing address

234 W CAMPBELL RD
RICHARDSON TX
75080-3512
US

V. Phone/Fax

Practice location:
  • Phone: 940-304-0189
  • Fax:
Mailing address:
  • Phone: 972-474-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140120
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: