Healthcare Provider Details

I. General information

NPI: 1811412372
Provider Name (Legal Business Name): BHAVINI GOPALDAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17571 N DAM ACCESS RD
WARSAW MO
65355-6396
US

IV. Provider business mailing address

420 W 15TH AVE
EMPORIA KS
66801-5367
US

V. Phone/Fax

Practice location:
  • Phone: 660-438-2717
  • Fax: 866-208-0157
Mailing address:
  • Phone: 620-342-4864
  • Fax: 620-343-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02006
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: