MEDICARE: NISHANT B JALANDHARA MD

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	207RN0300X	Nephrology Physician	0435141	KS
2	207RN0300X	Nephrology Physician	15251	NV
3	207RH0005X	Hypertension Specialist Physician	0435141	KS
4	207RN0300X	Nephrology Physician	Q5824	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932116902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHANT B JALANDHARA MD

Provider Business Mailing Address
First Line	:	1000 W CANNON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3029
Country	:	US
Telephone Number	:	817-725-7900
Fax Number	:	682-207-1030

Provider Business Practice Location Address
First Line	:	4420 HERITAGE TRACE PKWY STE 312
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8904
Country	:	US
Telephone Number	:	817-877-5858
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	02/19/2019

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Directions to “ NISHANT B JALANDHARA MD” Practice Location

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