Provider Demographics
NPI:1790309839
Name:PATEL, KHUSHBU R
Entity Type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 S 31ST ST APT 9302
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7170
Mailing Address - Country:US
Mailing Address - Phone:815-258-6942
Mailing Address - Fax:
Practice Address - Street 1:2012 S 31ST ST APT 9302
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7170
Practice Address - Country:US
Practice Address - Phone:815-258-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX969942163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse