Provider Demographics
NPI:1225719206
Name:DESAI-PANDYA, NIDHI (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:DESAI-PANDYA
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15513 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9134
Mailing Address - Country:US
Mailing Address - Phone:918-497-6120
Mailing Address - Fax:
Practice Address - Street 1:15513 BOULDER DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9134
Practice Address - Country:US
Practice Address - Phone:918-497-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK213528363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner