Healthcare Provider Details

I. General information

NPI: 1558713263
Provider Name (Legal Business Name): DHARSHANA KRISHNAPRASADH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

309 N SLIDE RD
LUBBOCK TX
79416-1549
US

V. Phone/Fax

Practice location:
  • Phone: 806-775-8200
  • Fax:
Mailing address:
  • Phone: 806-761-0972
  • Fax: 806-775-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberT5601
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: