Provider Demographics
NPI:1578735106
Name:GEORGEKUTTY, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GEORGEKUTTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1601 E DEBBIE LN
Mailing Address - Street 2:SUITE 2109
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3674
Mailing Address - Country:US
Mailing Address - Phone:817-473-9125
Mailing Address - Fax:817-473-9126
Practice Address - Street 1:1601 E DEBBIE LN
Practice Address - Street 2:SUITE 2109
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3674
Practice Address - Country:US
Practice Address - Phone:817-473-9125
Practice Address - Fax:817-473-9126
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196505502Medicaid
TX196505502Medicaid