Provider Demographics
NPI:1851703854
Name:KRISHNANKUTTY, JAYASREE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAYASREE
Middle Name:
Last Name:KRISHNANKUTTY
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 1:8585 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:APT 1014
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6863
Mailing Address - Country:US
Mailing Address - Phone:408-348-0987
Mailing Address - Fax:
Practice Address - Street 1:1420 W WELLS BRANCH PKWY
Practice Address - Street 2:SUITE #450
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3101
Practice Address - Country:US
Practice Address - Phone:512-806-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-24
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51603363A00000X
TXPA10762363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant