Provider Demographics
NPI:1578983052
Name:VARGHESE, PRINCY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PRINCY
Middle Name:
Last Name:VARGHESE
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 1:6800 HARRIS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4246
Mailing Address - Country:US
Mailing Address - Phone:817-292-0088
Mailing Address - Fax:817-292-8288
Practice Address - Street 1:6800 HARRIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4246
Practice Address - Country:US
Practice Address - Phone:817-292-0088
Practice Address - Fax:817-292-8288
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX464989ZMPVMedicare PIN
TX374245YPWUMedicare PIN