Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | K9697 | TX |
Y | 207R00000X | Internist | K9697 | TX |
Y | 111NI0900X | Internist | K9697 | TX |
NPI | 1346246964 |
---|---|
Provider Name | Dr. Kavita S Vyas |
First Address | Nacogdoches, TX 75965-1247 |
Second Address | Nacogdoches, TX 75965-1247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 19/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043017501 | (05) | TX |
H27634 | (02) | TX |