Healthcare Provider Details

I. General information

NPI: 1336777424
Provider Name (Legal Business Name): BALDISH KAUR KHERA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13507 N 145TH DR
SURPRISE AZ
85379-6162
US

IV. Provider business mailing address

4120 N 108TH AVE
PHOENIX AZ
85037-5773
US

V. Phone/Fax

Practice location:
  • Phone: 26-811-2742
  • Fax: 202-335-6336
Mailing address:
  • Phone: 623-925-0636
  • Fax: 202-335-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247837
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: