Provider Demographics
NPI:1558968552
Name:DESAI, KHUSBU DEVANG (NP)
Entity Type:Individual
Prefix:
First Name:KHUSBU
Middle Name:DEVANG
Last Name:DESAI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MCCLOUD CT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-4110
Mailing Address - Country:US
Mailing Address - Phone:864-208-7205
Mailing Address - Fax:
Practice Address - Street 1:75 E MCBEE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2737
Practice Address - Country:US
Practice Address - Phone:864-241-5199
Practice Address - Fax:864-241-5198
Is Sole Proprietor?:No
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily