Provider Demographics
NPI:1912593252
Name:MAHABOONPACHAI, SOPA (APRN/FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SOPA
Middle Name:
Last Name:MAHABOONPACHAI
Suffix:
Gender:F
Credentials:APRN/FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 PORTRAIT LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3847
Mailing Address - Country:US
Mailing Address - Phone:972-212-9431
Mailing Address - Fax:
Practice Address - Street 1:7709 SAN JACINTO PL STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3369
Practice Address - Country:US
Practice Address - Phone:972-491-1200
Practice Address - Fax:469-208-4641
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily