Individual
SMITHA SYAMALA KOMATREDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
823 IRA E WOODS AVE STE 200, GRAPEVINE, TX 76051-4096
(817) 722-6078
Mailing address
121 CROSS TIMBERS TRL, COPPELL, TX 75019-6714
(203) 273-6206
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1102099
TX
Other
Enumeration date
07/08/2025
Last updated
07/08/2025
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