Provider Demographics
NPI:1093066409
Name:KORUTHU, BELSY JOSE (WHCNP)
Entity Type:Individual
Prefix:
First Name:BELSY
Middle Name:JOSE
Last Name:KORUTHU
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N MCDONALD ST
Mailing Address - Street 2:135
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-2141
Mailing Address - Country:US
Mailing Address - Phone:972-548-5529
Mailing Address - Fax:972-548-5550
Practice Address - Street 1:825 N MCDONALD ST
Practice Address - Street 2:135
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-2141
Practice Address - Country:US
Practice Address - Phone:972-548-5529
Practice Address - Fax:972-548-5550
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505872363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health