Healthcare Provider Details

I. General information

NPI: 1477033389
Provider Name (Legal Business Name): BHADRESHKUMAR H PATEL NP STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 MORSE RD
COLUMBUS OH
43229-5858
US

IV. Provider business mailing address

2260 MORSE RD
COLUMBUS OH
43229-5858
US

V. Phone/Fax

Practice location:
  • Phone: 614-702-7899
  • Fax: 614-706-1570
Mailing address:
  • Phone: 614-702-7899
  • Fax: 614-706-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number388067
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number025184
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: