Provider Demographics
NPI:1386372001
Name:THEKKEKARA, NINA
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:THEKKEKARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:CHERIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:411 N WASHINGTON AVE STE 6000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1789
Practice Address - Country:US
Practice Address - Phone:214-366-2300
Practice Address - Fax:214-579-6988
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX895744163W00000X
TX1074738363LA2100X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1074738OtherTX NURSES LICENSE