=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811412372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BHAVINI GOPALDAS PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2017
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17571 N DAM ACCESS RD
-----------------------------------------------------
City | WARSAW
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65355-6396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-438-2717
-----------------------------------------------------
Fax | 866-208-0157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 W 15TH AVE
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-5367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-342-4864
-----------------------------------------------------
Fax | 620-343-3545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 15-02006
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------