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General NPI Number Information
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NPI Number | 1295489607
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Entity Type | Individual
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Provider Name | JAISHREE RAGHAVAN APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/05/2022
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 1300 S UNIVERSITY DR STE 306
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City | FORT WORTH
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State | TX
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Zip | 76107-5746
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Country | US
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Telephone | 844-824-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 2718 FERNCREST TRL
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City | MANSFIELD
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State | TX
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Zip | 76063-7591
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Country | US
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Telephone | 817-713-2757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1069904
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License Number State | TX
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