Provider Demographics
NPI:1376061820
Name:PRAVIN-PATEL, KOMAL (FNP)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:PRAVIN-PATEL
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 1:10670 N CENTRAL EXPY STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2130
Mailing Address - Country:US
Mailing Address - Phone:214-692-8541
Mailing Address - Fax:214-242-1035
Practice Address - Street 1:10670 N CENTRAL EXPY STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2130
Practice Address - Country:US
Practice Address - Phone:214-692-8541
Practice Address - Fax:214-242-1035
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134770363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner