Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP125526 | TX |
NPI | 1053863282 |
---|---|
Provider Name | Mr. Prachanda Khadka |
First Address | Apo, AE 09180-0000 |
Second Address | Apo, AE 09180-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2016 |
Last Update Date | 18/05/2021 |