Healthcare Provider Details

I. General information

NPI: 1457812703
Provider Name (Legal Business Name): PREETAM NALLU REDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SPRINGHILL DR STE 400
NORTH LITTLE ROCK AR
72117-2910
US

IV. Provider business mailing address

78-6831 ALII DR STE 328
KAILUA KONA HI
96740-4408
US

V. Phone/Fax

Practice location:
  • Phone: 501-945-8838
  • Fax: 501-945-8835
Mailing address:
  • Phone: 808-747-8321
  • Fax: 808-331-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-24516
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: