MEDICARE: GNNANASRIBALA MUKKAMALA NP

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
1	363LP2300X	Primary Care Nurse Practitioner	F09250582	TX

General Provider Information

NPI Number	:	1457225518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GNNANASRIBALA MUKKAMALA NP

Provider Business Mailing Address
First Line	:	8319 HIDDEN TRAIL LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-8723
Country	:	US
Telephone Number	:	832-454-6042
Fax Number	:	281-605-6656

Provider Business Practice Location Address
First Line	:	3600 S GESSNER RD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5150
Country	:	US
Telephone Number	:	281-463-1400
Fax Number	:	281-463-1432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	01/11/2026

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