Healthcare Provider Details

I. General information

NPI: 1962194696
Provider Name (Legal Business Name): NIKEETA PRIYANKA REDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST
LUBBOCK TX
79430-2933
US

IV. Provider business mailing address

3601 4TH ST
LUBBOCK TX
79430-2933
US

V. Phone/Fax

Practice location:
  • Phone: 469-789-9860
  • Fax:
Mailing address:
  • Phone: 806-743-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW7756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: