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General NPI Number Information
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NPI Number | 1114831989
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Entity Type | Organization
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Legal Business Name | IRIS MIND & WELLNESS, PLLC
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 121 CROSS TIMBERS TRL
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City | COPPELL
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State | TX
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Zip | 75019-6714
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Country | US
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Telephone | 203-273-6206
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Fax |
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Provider Business Mailing Address
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Address Line | 121 CROSS TIMBERS TRL
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City | COPPELL
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State | TX
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Zip | 75019-6714
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Country | US
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Telephone | 203-273-6206
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. SMITHA SYAMALA KOMATREDDY
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Credential | DNP, PMHNP-BC
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Telephone | 203-273-6206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | NULL
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