Provider Demographics
NPI:1528470200
Name:PRABHA, NANJUNDA (MD)
Entity type:Individual
Prefix:
First Name:NANJUNDA
Middle Name:
Last Name:PRABHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 SW9TH AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4178
Mailing Address - Country:US
Mailing Address - Phone:806-553-5859
Mailing Address - Fax:
Practice Address - Street 1:1217 BATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-8912
Practice Address - Country:US
Practice Address - Phone:870-262-2800
Practice Address - Fax:870-262-2810
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11580207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine