Provider Demographics
NPI:1194422840
Name:GANGADHARAN, BHAGYALEKSHMY VENNARAPARAMBIL (PMHNP)
Entity type:Individual
Prefix:
First Name:BHAGYALEKSHMY
Middle Name:VENNARAPARAMBIL
Last Name:GANGADHARAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 W BUSINESS 83
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3556
Mailing Address - Country:US
Mailing Address - Phone:956-444-0111
Mailing Address - Fax:
Practice Address - Street 1:3701 W BUSINESS 83
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3556
Practice Address - Country:US
Practice Address - Phone:956-444-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1104540364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health