Provider Demographics
NPI:1922193150
Name:REDDY, NALINI NARAYANA (MD)
Entity Type:Individual
Prefix:
First Name:NALINI
Middle Name:NARAYANA
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 U OF A WAY
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1419
Mailing Address - Country:US
Mailing Address - Phone:870-779-6000
Mailing Address - Fax:870-779-6050
Practice Address - Street 1:3417 U OF A WAY
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1419
Practice Address - Country:US
Practice Address - Phone:870-779-6000
Practice Address - Fax:870-779-6050
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1922193150Medicaid
AR1922193150OtherMEDICARE