Individual
MRS. NISHA ASHOK PATEL PRABHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 VERSAILLES RD, FRANKFORT, KY 40601-3857
(502) 695-3946
Mailing address
601 VERSAILLES RD, FRANKFORT, KY 40601-3857
(502) 695-3946
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TC340
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61-1358646
FEDERAL TAX NUMBER
KY
Enumeration date
11/04/2014
Last updated
11/04/2014
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