Provider Demographics
NPI:1477270007
Name:KOROUS, DEEBA (NP)
Entity Type:Individual
Prefix:
First Name:DEEBA
Middle Name:
Last Name:KOROUS
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 1:2942 S BUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-6907
Mailing Address - Country:US
Mailing Address - Phone:214-381-1187
Mailing Address - Fax:214-381-7213
Practice Address - Street 1:2942 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6907
Practice Address - Country:US
Practice Address - Phone:214-381-1187
Practice Address - Fax:214-381-7213
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1097435363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner