MEDICARE: KESHAVAN KODANDAPANI APN

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	164W00000X	Licensed Practical Nurse	APN000923	NV
2	363L00000X	Nurse Practitioner	APRN000923	NV

General Provider Information

NPI Number	:	1124167440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESHAVAN KODANDAPANI APN

Provider Business Mailing Address
First Line	:	1800 W. CHARLESTON BLVD.
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-383-2688
Fax Number	:	702-952-3364

Provider Business Practice Location Address
First Line	:	5757 WAYNE NEWTON BLVD.
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89111
Country	:	US
Telephone Number	:	702-383-2527
Fax Number	:	702-383-1991

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/06/2021

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Directions to “ KESHAVAN KODANDAPANI APN” Practice Location

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