Provider Demographics
NPI:1588114086
Name:PATEL, SWETKETUKUMAR M (NP-C)
Entity type:Individual
Prefix:
First Name:SWETKETUKUMAR
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NORTHWEST HWY
Mailing Address - Street 2:3713
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3505
Mailing Address - Country:US
Mailing Address - Phone:804-588-8780
Mailing Address - Fax:
Practice Address - Street 1:900 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3902
Practice Address - Country:US
Practice Address - Phone:817-877-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily