Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT203402 | PA |
N | 111NI0900X | Internist | MT203402 | PA |
Y | 207RH0003X | Hematology & Oncology | 2022000584 | MO |
N | 207RH0003X | Hematology & Oncology | MD459024 | PA |
NPI | 1003256645 |
---|---|
Provider Name | Vineela Kasireddy |
First Address | Jefferson City, MO 65109-2444 |
Second Address | Jefferson City, MO 65109-2444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 04/02/2022 |