Individual
MRS. NISHA THEKKEDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7201
(214) 645-2800
(214) 645-2808
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 645-2800
(214) 645-2808
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
841763
TX
363LA2100X
Acute Care Nurse Practitioner
841763
TX
Other
Enumeration date
08/17/2013
Last updated
01/29/2014
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