Healthcare Provider Details

I. General information

NPI: 1538606009
Provider Name (Legal Business Name): SRIJANA POUDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 N MACARTHUR BLVD STE 103
IRVING TX
75062-4404
US

IV. Provider business mailing address

6344 DAVIS BLVD
N RICHLAND HILLS TX
76180-4762
US

V. Phone/Fax

Practice location:
  • Phone: 940-782-6642
  • Fax:
Mailing address:
  • Phone: 817-849-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP131930
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024175915
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: