Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP129502 | TX |
NPI | 1013380963 |
---|---|
Provider Name | Deepika Thankanchan |
First Address | Flower Mound, TX 75028-8824 |
Second Address | Flower Mound, TX 75028-8824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2015 |
Last Update Date | 14/06/2019 |