Basic Information
| Provider Information | |||||||||
| NPI: | 1821346263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUPPANNAGARI | ||||||||
| FirstName: | JYOTSNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 S HIGHWAY 78 STE 106 | ||||||||
| Address2: | |||||||||
| City: | WYLIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750983915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619441190 | ||||||||
| FaxNumber: | 9724295410 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 S HIGHWAY 78 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WYLIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750983944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728019689 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME115733 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | Q2680 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.