Individual
PRAVEENA JYOTHINAGARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4491 LONG PRAIRIE RD STE 200, FLOWER MOUND, TX 75028-2012
(469) 645-0202
Mailing address
1600 WATERS RIDGE DR STE A, LEWISVILLE, TX 75057-6039
(972) 219-0558
(214) 466-7237
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Q4780
TX
207RN0300X
Nephrology Physician
Primary
Q4780
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350271801
—
TX
Enumeration date
07/23/2007
Last updated
08/27/2024
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