Provider Demographics
NPI:1275889198
Name:MYLAVARAPU, KRISHNA CHAITANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:CHAITANYA
Last Name:MYLAVARAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1699 HARRISON ST
Mailing Address - Street 2:SUITE D.
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7302
Mailing Address - Country:US
Mailing Address - Phone:870-262-6282
Mailing Address - Fax:870-262-6290
Practice Address - Street 1:1699 HARRISON ST
Practice Address - Street 2:SUITE D.
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7302
Practice Address - Country:US
Practice Address - Phone:870-262-6282
Practice Address - Fax:870-262-6290
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-83992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology