Provider Demographics
NPI:1831208966
Name:ANUMANDLA, PRASHANTH R (ANP-BC, RN)
Entity type:Individual
Prefix:MR
First Name:PRASHANTH
Middle Name:R
Last Name:ANUMANDLA
Suffix:
Gender:M
Credentials:ANP-BC, RN
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Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1901, SMITH TOWER
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-1100
Mailing Address - Fax:713-790-2643
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1901, SMITH TOWER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-441-1100
Practice Address - Fax:713-790-2643
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI139357363L00000X
TX761283363L00000X
TXAP116895363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199955902Medicaid
TXP00741122OtherRAILROAD MEDICARE
LA1822558Medicaid
TX199955904Medicaid
WI41191300Medicaid
TXP01037103OtherRR MEDICARE
TX8Y9191OtherBLUE CROSS BLUE SHIELD
TX199955901Medicaid
TXP01037103OtherRR MEDICARE
WI026339295Medicare ID - Type Unspecified
TXTXB145693Medicare PIN
TX8L4079Medicare PIN