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General NPI Number Information
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NPI Number | 1568854537
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Entity Type | Individual
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Provider Name | MARYKUTTY PRASAD RN,FNP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 22135 W INTERSTATE 10
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1621
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Country | US
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Telephone | 210-219-2246
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Fax |
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Provider Business Mailing Address
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Address Line | 22135 I H- 10 W CVS MINUTE CLINIC
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City | SAN ANTONIO
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State | TX
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Zip | 78257-3301
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Country | US
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Telephone | 210-698-1643
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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 | 364SC0200X
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Taxonomy Name | Critical Care Medicine Clinical Nurse Specialist
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License Number | 699647
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP120772
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License Number State | TX
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