Healthcare Provider Details

I. General information

NPI: 1306687728
Provider Name (Legal Business Name): YASHMERI KUILAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E OAK ST STE 102
MANSFIELD TX
76063-7713
US

IV. Provider business mailing address

3507 WEYBURN DR
MANSFIELD TX
76084-1174
US

V. Phone/Fax

Practice location:
  • Phone: 817-487-5098
  • Fax:
Mailing address:
  • Phone: 817-487-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: