Individual
DR. NIVEDITA PRASANNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-5000
(731) 660-8739
Mailing address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-5000
(731) 660-8739
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
61203
TN
390200000X
Student in an Organized Health Care Education/Training Program
125067100
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/24/2015
Last updated
04/05/2021
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