Provider Demographics
NPI:1912142977
Name:KURIAKOSE, JOFY S
Entity type:Individual
Prefix:
First Name:JOFY
Middle Name:S
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:
Practice Address - Street 1:3300 DALLAS PKWY STE 224
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7771
Practice Address - Country:US
Practice Address - Phone:972-573-3157
Practice Address - Fax:855-828-0878
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760576363LF0000X
TXAP117061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198641601Medicaid
TX198641603Medicaid
TX198641602Medicaid
TX8L5977Medicare PIN
TX8L6064Medicare PIN
TX198641603Medicaid