MEDICARE: NANCY YEDANAPALLI PNP

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	363LP0200X	Pediatric Nurse Practitioner	1015904	TX

General Provider Information

NPI Number	:	1568060564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY YEDANAPALLI PNP

Provider Business Mailing Address
First Line	:	2814 MORENO ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-2916
Country	:	US
Telephone Number	:	312-731-4096
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 MEDICAL PKWY STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3332
Country	:	US
Telephone Number	:	512-731-4095
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	11/01/2020

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