Individual
VIDYA NANDINI BALKISHUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18947 JOHN J WILLIAMS HWY UNIT 101, REHOBOTH BEACH, DE 19971-4480
(302) 645-3770
(302) 645-5718
Mailing address
1915 WHITE AVE, KNOXVILLE, TN 37916-2300
(865) 331-1720
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C5-0012102
DE
363AM0700X
Medical Physician Assistant
4813
TN
363AM0700X
Medical Physician Assistant
MA051675
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q070965
—
TN
Enumeration date
01/15/2007
Last updated
10/21/2024
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