Provider Demographics
NPI:1326234600
Name:NAKKALA, KIRAN R (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:R
Last Name:NAKKALA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7217 HOLMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7509
Mailing Address - Country:US
Mailing Address - Phone:347-327-0404
Mailing Address - Fax:910-323-1913
Practice Address - Street 1:1880 QUIET CV
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3857
Practice Address - Country:US
Practice Address - Phone:910-323-2477
Practice Address - Fax:910-323-1913
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12730207R00000X
NY004009207RG0100X
NC201501965207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCQ031AMedicare UPIN