MEDICARE: MRS. BHAGYA LAKSHMI BALASA 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	363LA2200X	Adult Health Nurse Practitioner	AP131416	TX
2	363LG0600X	Gerontology Nurse Practitioner	AP131416	TX

General Provider Information

NPI Number	:	1578016291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BHAGYA LAKSHMI BALASA NP

Provider Business Mailing Address
First Line	:	4001 BASHFUL DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-6977
Country	:	US
Telephone Number	:	732-859-7429
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 BASHFUL DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-6977
Country	:	US
Telephone Number	:	732-859-7429
Fax Number	:

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

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	07/28/2016

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