Provider Demographics
NPI:1386003572
Name:PRADHAN, IRFAN (NP)
Entity Type:Individual
Prefix:MR
First Name:IRFAN
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4772 NAVY RD STE A
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1927
Mailing Address - Country:US
Mailing Address - Phone:901-873-0930
Mailing Address - Fax:901-873-0931
Practice Address - Street 1:4772 NAVY RD STE A
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1927
Practice Address - Country:US
Practice Address - Phone:901-873-0930
Practice Address - Fax:901-873-0931
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY684695-1163W00000X
NYF338871-1363LF0000X
TN21813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse