Provider Demographics
NPI:1912996497
Name:REDDY, KRISHNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:437 DENISON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6127
Mailing Address - Country:US
Mailing Address - Phone:501-327-1325
Mailing Address - Fax:501-327-1328
Practice Address - Street 1:437 DENISON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6127
Practice Address - Country:US
Practice Address - Phone:501-327-1325
Practice Address - Fax:501-327-1328
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR3046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770163401OtherMEDICAID BREAST CARE
AR060000204OtherRAILROAD MEDICARE
AR106214001Medicaid
AR0420244OtherUNITED HEALTHCARE
AR54277OtherBLUECROSS BLUE SHIELD
AR71024973572031019OtherCHAMPUS
AR770163401OtherMEDICAID BREAST CARE
ARD08973Medicare UPIN