Healthcare Provider Details

I. General information

NPI: 1851069603
Provider Name (Legal Business Name): DEEPA L DAVID NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 W MOORE AVE STE 206
TERRELL TX
75160-2372
US

IV. Provider business mailing address

1446 W MOORE AVE STE 206
TERRELL TX
75160-2372
US

V. Phone/Fax

Practice location:
  • Phone: 972-210-7350
  • Fax: 972-210-7355
Mailing address:
  • Phone: 972-210-7350
  • Fax: 972-210-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP137361
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: