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General NPI Number Information
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NPI Number | 1295243848
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Entity Type | Individual
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Provider Name | PRAVEEN BODAKUNTA PMHNP
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Gender | Male
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 300 LENORA ST STE 401
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City | SEATTLE
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State | WA
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Zip | 98121-2411
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Country | US
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Telephone | 206-699-8261
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Fax |
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Provider Business Mailing Address
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Address Line | 300 LENORA ST
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City | SEATTLE
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State | WA
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Zip | 98121-2411
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Country | US
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Telephone | 206-699-8261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 288853
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60909328
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 862811
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN60641646
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95023203
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | C-APN.0103995-C-NP
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License Number State | CO
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