Provider Demographics
NPI:1447301882
Name:CHAWLA, KUMUD (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KUMUD
Middle Name:
Last Name:CHAWLA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:KUMUD
Other - Middle Name:
Other - Last Name:CHAWLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2317 STARLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-6425
Mailing Address - Country:US
Mailing Address - Phone:817-277-5822
Mailing Address - Fax:817-277-5842
Practice Address - Street 1:2317 STARLIGHT CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-6425
Practice Address - Country:US
Practice Address - Phone:817-277-5822
Practice Address - Fax:817-277-5842
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513615363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00413519OtherMEDICARE RAILROAD
TX1491755-03Medicaid
TXP00413519OtherMEDICARE RAILROAD
TXP43688Medicare UPIN