Provider Demographics
NPI:1447731112
Name:KRISHNASAMY, PUNITHA (PMHNP- BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:PUNITHA
Middle Name:
Last Name:KRISHNASAMY
Suffix:
Gender:F
Credentials:PMHNP- BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6537 S STAPLES ST STE 125
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5423
Mailing Address - Country:US
Mailing Address - Phone:361-266-5189
Mailing Address - Fax:
Practice Address - Street 1:6537 S STAPLES ST STE 125
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5423
Practice Address - Country:US
Practice Address - Phone:361-266-5189
Practice Address - Fax:361-202-0072
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138242363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP138242OtherAPRN LICENSE