Healthcare Provider Details

I. General information

NPI: 1053816926
Provider Name (Legal Business Name): TAMANNA KAVISH JABEEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PRAIRIE DR STE 102
PROSPER TX
75078-3818
US

IV. Provider business mailing address

2120 PRAIRIE DR STE 102
PROSPER TX
75078-3818
US

V. Phone/Fax

Practice location:
  • Phone: 972-544-9455
  • Fax:
Mailing address:
  • Phone: 972-544-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT6598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: