Provider Demographics
NPI:1568290633
Name:PANICKER, JELITTA (APRN, PMHNP)
Entity type:Individual
Prefix:MS
First Name:JELITTA
Middle Name:
Last Name:PANICKER
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:MS
Other - First Name:JELITTA
Other - Middle Name:
Other - Last Name:PANICKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, PMHNP
Mailing Address - Street 1:297 ONTARIO LOOP
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-0033
Mailing Address - Country:US
Mailing Address - Phone:469-388-5425
Mailing Address - Fax:
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:469-388-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty