Provider Demographics
NPI:1619552031
Name:ANILKUMAR, AMBILIKUTTY X (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMBILIKUTTY
Middle Name:
Last Name:ANILKUMAR
Suffix:X
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 TAD PARK CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3533
Mailing Address - Country:US
Mailing Address - Phone:512-716-9258
Mailing Address - Fax:
Practice Address - Street 1:8500 TAD PARK CV
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3533
Practice Address - Country:US
Practice Address - Phone:512-716-9258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008773363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology