Provider Demographics
NPI:1346792694
Name:KURIAKOSE, MARYKUTTY (APN)
Entity Type:Individual
Prefix:
First Name:MARYKUTTY
Middle Name:
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8332 CHARLESTON ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8000
Mailing Address - Country:US
Mailing Address - Phone:214-714-7156
Mailing Address - Fax:
Practice Address - Street 1:4009 WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1608
Practice Address - Country:US
Practice Address - Phone:214-820-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMK2016363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health