Provider Demographics
NPI:1659977890
Name:JOHN, BLESSY KADAVIL (FNP)
Entity Type:Individual
Prefix:MS
First Name:BLESSY
Middle Name:KADAVIL
Last Name:JOHN
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 1:981 STATE HIGHWAY 121 STE 1140
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6148
Mailing Address - Country:US
Mailing Address - Phone:214-517-3703
Mailing Address - Fax:
Practice Address - Street 1:981 STATE HIGHWAY 121 STE 1140
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6148
Practice Address - Country:US
Practice Address - Phone:214-517-3703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33228363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care