Provider Demographics
NPI:1053750018
Name:ACHARYA, PRAKRATI (MBBS)
Entity type:Individual
Prefix:
First Name:PRAKRATI
Middle Name:
Last Name:ACHARYA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:PRAKRATI
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4801 ALBERTA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2707
Mailing Address - Country:US
Mailing Address - Phone:915-215-5700
Mailing Address - Fax:915-215-8641
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-215-5700
Practice Address - Fax:915-215-8641
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAZSSS43207R00000X
TXS1965207RN0300X
MS24462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03321553Medicaid
MS03321553Medicaid
MSP01721895Medicare PIN