Provider Demographics
NPI:1568737492
Name:BAGH, ROSE PAUL (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:PAUL
Last Name:BAGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ROSE
Other - Middle Name:E
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-8000
Mailing Address - Fax:214-645-7269
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-8000
Practice Address - Fax:214-645-7269
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX734412363LF0000X, 363L00000X
TXAP121607363LF0000X, 363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP121607OtherAPRN LICENSE NUMBER
TX734412OtherRN LICENSE NUMBER