MEDICARE: MANINDER KAUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	AP135418	TX
2	363LP2300X	Primary Care Nurse Practitioner	AP135418	TX

General Provider Information

NPI Number	:	1134634678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANINDER KAUR

Provider Business Mailing Address
First Line	:	756 E LAKE DR
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-7906
Country	:	US
Telephone Number	:	972-807-3600
Fax Number	:	972-807-3608

Provider Business Practice Location Address
First Line	:	201 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5857
Country	:	US
Telephone Number	:	817-987-1805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	04/08/2021

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Directions to “ MANINDER KAUR ” Practice Location

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