Provider Demographics
NPI:1659748499
Name:VANCHIPURAKAL, KAVYA (FNP-BC, BSN, RN)
Entity type:Individual
Prefix:
First Name:KAVYA
Middle Name:
Last Name:VANCHIPURAKAL
Suffix:
Gender:F
Credentials:FNP-BC, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MEDICAL DISTRICT DR APT 3102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-8278
Mailing Address - Country:US
Mailing Address - Phone:845-536-4809
Mailing Address - Fax:
Practice Address - Street 1:4708 ALLIANCE BLVD STE 550
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5363
Practice Address - Country:US
Practice Address - Phone:469-800-6580
Practice Address - Fax:469-800-6590
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704999163W00000X
TX1053765163W00000X, 363LF0000X
NY345824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse