MEDICARE: DR. NISHANT KUMAR ROUT D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	342892	LA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063101244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHANT KUMAR ROUT D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 2036
Second Line	:
City	:	PONCHATOULA
State	:	LA
Zip	:	70454-2036
Country	:	US
Telephone Number	:	985-386-7900
Fax Number	:	985-386-7999

Provider Business Practice Location Address
First Line	:	165 W OAK ST
Second Line	:
City	:	PONCHATOULA
State	:	LA
Zip	:	70454-3328
Country	:	US
Telephone Number	:	985-986-7900
Fax Number	:	985-386-7999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	06/17/2026

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