Active NPI
Patra Dear Rungruangphol
- Student in an Organized Health Care Education/Training Program
- Dallas, TX
National Provider Identifier
1568919256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 33063
- Practice address
- 13737 Noel Rd
Suite 1400
Dallas, TX 75240-1331 - Phone
- (214) 754-8700
- Fax
- (877) 764-3083
- NPI assigned
- Sep 9, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 33063 | TX | Primary |
Addresses
Primary practice location
13737 Noel Rd
Suite 1400
Dallas, TX 75240-1331
Mailing address
10124 Rita Rd
Dallas, TX 75243-2618
Phone (214) 734-3844
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33063 | TX | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473379200000",
"number": "1568919256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10124 RITA RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752432618",
"telephone_number": "214-734-3844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13737 NOEL RD",
"address_2": "SUITE 1400",
"city": "DALLAS",
"state": "TX",
"postal_code": "752401331",
"telephone_number": "214-754-8700",
"fax_number": "877-764-3083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUNGRUANGPHOL",
"first_name": "PATRA",
"middle_name": "DEAR",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-09",
"last_updated": "2016-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "TX",
"license": "33063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.