Provider Demographics
NPI:1790290070
Name:BHAKTA, YAMINIBEN (PA-C)
Entity Type:Individual
Prefix:
First Name:YAMINIBEN
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12234 SHADOW CREEK PKWY STE 4104
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7333
Mailing Address - Country:US
Mailing Address - Phone:713-429-5325
Mailing Address - Fax:
Practice Address - Street 1:12234 SHADOW CREEK PKWY STE 4104
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-429-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant