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NPI Code Detail

MEDICARE: DR. PRATHYUSHA REDDY MD

MEDICARE: DR. PRATHYUSHA REDDY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician20569KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120569OTHERKYSTATE LICENSE

General Provider Information

NPI Number : 1184636722
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRATHYUSHA REDDY MD
Provider Business Mailing Address
First Line : 458 HUTCHERSON RD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-8016
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 608 HAPPY VALLEY RD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1561
Country : US
Telephone Number : 270-901-5000
Fax Number : 270-651-9248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 03/07/2023

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