=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477033389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BHADRESHKUMAR H PATEL NP STUDENT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2018
-----------------------------------------------------
Last Update Date | 09/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2260 MORSE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43229-5858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-702-7899
-----------------------------------------------------
Fax | 614-706-1570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2260 MORSE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43229-5858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-702-7899
-----------------------------------------------------
Fax | 614-706-1570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | 388067
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 025184
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------