Healthcare Provider Details

I. General information

NPI: 1770034621
Provider Name (Legal Business Name): PRAVIN KESARI PANT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2016
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

9 HAWTHORNE PL APT 3L
BOSTON MA
02114-2344
US

V. Phone/Fax

Practice location:
  • Phone: 855-644-6387
  • Fax:
Mailing address:
  • Phone: 617-642-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2292188
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN2292188
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2292188
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2292188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: