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General NPI Number Information
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NPI Number | 1306046859
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Entity Type | Individual
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Provider Name | PRAVEENA JYOTHINAGARAM MD
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 4491 LONG PRAIRIE RD STE 200
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City | FLOWER MOUND
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State | TX
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Zip | 75028-2012
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Country | US
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Telephone | 469-645-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 WATERS RIDGE DR STE A
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City | LEWISVILLE
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State | TX
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Zip | 75057-6039
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Country | US
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Telephone | 972-219-0558
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Fax | 214-466-7237
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | Q4780
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | Q4780
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License Number State | TX
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