Provider Demographics
NPI:1386700151
Name:UPADHYAY, VISHNU M (FNP, WHCNP)
Entity type:Individual
Prefix:
First Name:VISHNU
Middle Name:M
Last Name:UPADHYAY
Suffix:
Gender:F
Credentials:FNP, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 LOWRIE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78034
Mailing Address - Country:US
Mailing Address - Phone:469-363-1940
Mailing Address - Fax:866-593-4785
Practice Address - Street 1:350 WESTPARK WAY STE 223
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3758
Practice Address - Country:US
Practice Address - Phone:817-283-4438
Practice Address - Fax:817-283-1792
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110510363LP0808X
TX633324363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX061252511Medicaid
TX061252511Medicaid