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General NPI Number Information
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NPI Number | 1649149097
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Entity Type | Individual
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Provider Name | JITTA ALEYA THARAKAN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 891 KELLER PKWY STE 101
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City | KELLER
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State | TX
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Zip | 76248-2486
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Country | US
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Telephone | 682-593-4273
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Fax |
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Provider Business Mailing Address
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Address Line | 891 KELLER PKWY STE 101
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City | KELLER
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State | TX
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Zip | 76248-2486
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Country | US
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Telephone | 214-733-9481
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1216719
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License Number State | TX
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