Provider Demographics
NPI:1275266108
Name:UPPAL, KOMAL NOOR KAUR (FNP)
Entity Type:Individual
Prefix:
First Name:KOMAL NOOR
Middle Name:KAUR
Last Name:UPPAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12443 OSWALT RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-7510
Mailing Address - Country:US
Mailing Address - Phone:972-339-8670
Mailing Address - Fax:
Practice Address - Street 1:12443 OSWALT RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448-7510
Practice Address - Country:US
Practice Address - Phone:972-339-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily