MEDICARE: SRIJANA POUDEL

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	363L00000X	Nurse Practitioner	AP131930	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024175915	VA

General Provider Information

NPI Number	:	1538606009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRIJANA POUDEL

Provider Business Mailing Address
First Line	:	6344 DAVIS BLVD
Second Line	:
City	:	N RICHLAND HILLS
State	:	TX
Zip	:	76180-4762
Country	:	US
Telephone Number	:	817-849-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 N MACARTHUR BLVD STE 103
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-4404
Country	:	US
Telephone Number	:	940-782-6642
Fax Number	:

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

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/27/2025

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