Individual
DR. KEERTHANA NAGAVENKATA BOLISETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1007 W RANDOL MILL RD STE 110, ARLINGTON, TX 76012-6503
(817) 617-7678
(817) 617-7678
Mailing address
3824 N TARRANT PKWY STE 310, FORT WORTH, TX 76244-5431
(817) 617-7678
(817) 617-7681
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
S1985
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
S1985
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400383205
—
TX
Enumeration date
03/30/2015
Last updated
10/23/2022
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