Provider Demographics
NPI:1528207164
Name:MOHAN, JHUDY (FNP-C)
Entity Type:Individual
Prefix:
First Name:JHUDY
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 CRESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3572
Mailing Address - Country:US
Mailing Address - Phone:972-289-1948
Mailing Address - Fax:
Practice Address - Street 1:3111 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-4028
Practice Address - Country:US
Practice Address - Phone:214-651-8739
Practice Address - Fax:214-379-2281
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily