Provider Demographics
NPI:1316609639
Name:BIMALI, YAGYA (APRN AGCNS-BC)
Entity type:Individual
Prefix:
First Name:YAGYA
Middle Name:
Last Name:BIMALI
Suffix:
Gender:M
Credentials:APRN AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 VENDEMMIA BND
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1166
Mailing Address - Country:US
Mailing Address - Phone:512-777-5974
Mailing Address - Fax:
Practice Address - Street 1:607 SCREECH OWL DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4617
Practice Address - Country:US
Practice Address - Phone:510-710-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056947364S00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology