Provider Demographics
NPI:1982044780
Name:KAILASH, VIDYA (PA-C)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:KAILASH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3639 WARREN WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5398
Mailing Address - Country:US
Mailing Address - Phone:775-827-3639
Mailing Address - Fax:775-827-3638
Practice Address - Street 1:3639 WARREN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5398
Practice Address - Country:US
Practice Address - Phone:775-827-3639
Practice Address - Fax:775-827-3638
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant