Provider Demographics
NPI:1932116902
Name:JALANDHARA, NISHANT B (MD)
Entity Type:Individual
Prefix:
First Name:NISHANT
Middle Name:B
Last Name:JALANDHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-725-7900
Mailing Address - Fax:682-207-1030
Practice Address - Street 1:4420 HERITAGE TRACE PKWY STE 312
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8904
Practice Address - Country:US
Practice Address - Phone:817-877-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0435141207RN0300X, 207RH0005X
NV15251207RN0300X
TXQ5824207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1920916Medicaid
TX352419101Medicaid
NVV107690Medicare PIN