MEDICARE: KRISHNA PATEL

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	363L00000X	Nurse Practitioner	95026342	CA
2	363LF0000X	Family Nurse Practitioner	95026342	CA

General Provider Information

NPI Number	:	1477325314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISHNA PATEL

Provider Business Mailing Address
First Line	:	2216 CORAL AVE
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-1590
Country	:	US
Telephone Number	:	386-366-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	2216 CORAL AVE
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-1590
Country	:	US
Telephone Number	:	386-366-0023
Fax Number	:

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

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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Directions to “ KRISHNA PATEL ” Practice Location

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