Provider Demographics
NPI:1043779465
Name:JOSEPH, KOCHURANI (NP)
Entity Type:Individual
Prefix:
First Name:KOCHURANI
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 N 22ND LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5757
Mailing Address - Country:US
Mailing Address - Phone:956-279-8447
Mailing Address - Fax:
Practice Address - Street 1:717 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6616
Practice Address - Country:US
Practice Address - Phone:956-331-6063
Practice Address - Fax:956-682-4505
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140910208000000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP140910OtherFAMILY NURSE PRACTITIONER LICENSE