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General NPI Number Information
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NPI Number | 1356912547
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Entity Type | Individual
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Provider Name | VAISHNAVI THEEGALA MD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 4301 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-526-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 603 SUFFOLK RD
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City | JOHNSON CITY
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State | TN
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Zip | 37615-3993
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Country | US
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Telephone | 740-272-8364
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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