Provider Demographics
NPI:1417607623
Name:KOTA, NAGAMANI
Entity Type:Individual
Prefix:
First Name:NAGAMANI
Middle Name:
Last Name:KOTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 PARKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2238
Mailing Address - Country:US
Mailing Address - Phone:240-281-9725
Mailing Address - Fax:
Practice Address - Street 1:2450 PARKWOOD LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2238
Practice Address - Country:US
Practice Address - Phone:240-281-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX973772163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse