Healthcare Provider Details

I. General information

NPI: 1285171751
Provider Name (Legal Business Name): UPKAR KAUR BADHESHA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 E SHAW AVE STE 410
FRESNO CA
93710-7904
US

IV. Provider business mailing address

1060 W SIERRA AVE # 104
FRESNO CA
93711-2063
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-1316
  • Fax: 559-226-1315
Mailing address:
  • Phone: 559-437-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number807278
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: