Healthcare Provider Details

I. General information

NPI: 1891972758
Provider Name (Legal Business Name): JAY ARACKAL KRISHNAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAYAKRISHNAN ARACKAL KRISHNAKURUP

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10619 PROFESSIONAL CIR
RENO NV
89521-5831
US

IV. Provider business mailing address

10619 PROFESSIONAL CIR
RENO NV
89521-5831
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-4600
  • Fax: 775-329-4992
Mailing address:
  • Phone: 775-329-4600
  • Fax: 775-329-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number19090
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: