Provider Demographics
NPI:1235734070
Name:BONTHU, LAKSHMI PRATYUSHARED (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:LAKSHMI PRATYUSHARED
Middle Name:
Last Name:BONTHU
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 SAWMILL RD APT 703
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2103
Mailing Address - Country:US
Mailing Address - Phone:832-589-6973
Mailing Address - Fax:
Practice Address - Street 1:151 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-6604
Practice Address - Country:US
Practice Address - Phone:830-334-4142
Practice Address - Fax:830-334-8470
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX927149163W00000X
TX1037461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse