Provider Demographics
NPI:1598504615
Name:MANTRI, KRUSHNA
Entity type:Individual
Prefix:
First Name:KRUSHNA
Middle Name:
Last Name:MANTRI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7211
Mailing Address - Fax:
Practice Address - Street 1:2755 SILVER CREEK RD STE 217
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8361
Practice Address - Country:US
Practice Address - Phone:928-704-6070
Practice Address - Fax:928-704-4736
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant