Healthcare Provider Details

I. General information

NPI: 1639012818
Provider Name (Legal Business Name): DEEPIKA KRISHNA MUKKAVILLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SPRINGHILL DR STE 400
NORTH LITTLE ROCK AR
72117-2008
US

IV. Provider business mailing address

3201 SPRINGHILL DR STE 400
NORTH LITTLE ROCK AR
72117-2008
US

V. Phone/Fax

Practice location:
  • Phone: 501-945-8838
  • Fax:
Mailing address:
  • Phone: 501-945-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: