Individual provider Active NPI

Surya Raju

  • Nurse Practitioner
  • Carrollton, TX
National Provider Identifier
1508787094
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1245090 Issued in TX
Practice address
1199 Lakefirth Path
Carrollton, TX 75010-4322
Phone
(469) 655-8687
NPI assigned
Jul 22, 2026
Last updated
Aug 31, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1245090 TX Primary

Addresses

Primary practice location

1199 Lakefirth Path
Carrollton, TX 75010-4322

Mailing address

1199 Lakefirth Path
Carrollton, TX 75010-4322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1784678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1508787094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1199 LAKEFIRTH PATH",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 LAKEFIRTH PATH",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104322",
            "telephone_number": "469-655-8687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJU",
        "first_name": "SURYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-07-22",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1245090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.