Provider Demographics
NPI:1073059655
Name:BHAKTA, KEATA (AGACNP, RN)
Entity Type:Individual
Prefix:
First Name:KEATA
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:AGACNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 E ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1581
Mailing Address - Country:US
Mailing Address - Phone:480-703-4720
Mailing Address - Fax:
Practice Address - Street 1:721 E ELGIN ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1581
Practice Address - Country:US
Practice Address - Phone:480-703-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9759363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care