Healthcare Provider Details

I. General information

NPI: 1346472206
Provider Name (Legal Business Name): PRAKASH SHRESTHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 24TH ST STE 403
LUBBOCK TX
79410-1804
US

IV. Provider business mailing address

2215 NASHVILLE AVE
LUBBOCK TX
79410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-7150
  • Fax: 806-723-6136
Mailing address:
  • Phone: 806-725-4800
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberR0129
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT194269
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: