Healthcare Provider Details

I. General information

NPI: 1750946208
Provider Name (Legal Business Name): NIKITA KHETARPAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 07/15/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N PAULINE ST
MEMPHIS TN
38104-1005
US

IV. Provider business mailing address

116 N PAULINE ST
MEMPHIS TN
38104-1005
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax:
Mailing address:
  • Phone: 901-523-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number68929
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: