Healthcare Provider Details

I. General information

NPI: 1083956940
Provider Name (Legal Business Name): ROSHNI PATEL CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 SH 276
ROCKWALL TX
75032-2569
US

IV. Provider business mailing address

1861 SH 276
ROCKWALL TX
75032-2569
US

V. Phone/Fax

Practice location:
  • Phone: 972-722-4992
  • Fax: 972-722-4995
Mailing address:
  • Phone: 972-722-4992
  • Fax: 972-722-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number768719
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP123059
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: