Provider Demographics
NPI:1568060564
Name:YEDANAPALLI, NANCY (PNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:YEDANAPALLI
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:YEDANAPALLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNP
Mailing Address - Street 1:2814 MORENO ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2916
Mailing Address - Country:US
Mailing Address - Phone:312-731-4096
Mailing Address - Fax:
Practice Address - Street 1:4314 MEDICAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3332
Practice Address - Country:US
Practice Address - Phone:512-731-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015904363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics