Provider Demographics
NPI:1710316880
Name:NARAHARISETTY, VANI (PA-C)
Entity Type:Individual
Prefix:
First Name:VANI
Middle Name:
Last Name:NARAHARISETTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 HIGHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-9536
Mailing Address - Country:US
Mailing Address - Phone:601-450-2034
Mailing Address - Fax:
Practice Address - Street 1:101 ASBURY CIRCLE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1150
Practice Address - Country:US
Practice Address - Phone:601-450-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00194363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical