Individual
MRS. BHAVANA AKOTIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
910 E HOUSTON ST, STE 550, TYLER, TX 75702-8369
(903) 510-8718
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA08632
TX
363A00000X
Physician Assistant
PA20070008
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19688571
—
NM
05
—
327622201
—
TX
01
—
75-2616977-008
TRICARE
TX
01
—
8558ND
BCBS
TX
01
—
P01304529
RAIL ROAD
TX
Enumeration date
04/18/2007
Last updated
11/24/2014
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