Provider Demographics
NPI:1811412372
Name:GOPALDAS, BHAVINI (PA)
Entity Type:Individual
Prefix:
First Name:BHAVINI
Middle Name:
Last Name:GOPALDAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5367
Mailing Address - Country:US
Mailing Address - Phone:620-342-4864
Mailing Address - Fax:620-343-3545
Practice Address - Street 1:1602 N ELM ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:KS
Practice Address - Zip Code:67045-1090
Practice Address - Country:US
Practice Address - Phone:620-583-7436
Practice Address - Fax:620-583-6848
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-02006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant