Individual
KOMALI ATHOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14197 DANEHURST LN, FRISCO, TX 75035-1310
(912) 401-1124
Mailing address
14197 DANEHURST LN, FRISCO, TX 75035-1310
(912) 401-1124
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
1053939
TX
363LG0600X
Gerontology Nurse Practitioner
1053939
TX
Other
Enumeration date
11/10/2022
Last updated
11/10/2022
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