Provider Demographics
NPI:1205464138
Name:KC, NIRANJAN (PA-C)
Entity type:Individual
Prefix:
First Name:NIRANJAN
Middle Name:
Last Name:KC
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5040 ADDISON CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6049
Mailing Address - Country:US
Mailing Address - Phone:214-983-0300
Mailing Address - Fax:214-983-0301
Practice Address - Street 1:2419 W SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1506
Practice Address - Country:US
Practice Address - Phone:469-535-6842
Practice Address - Fax:817-809-2661
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA13549363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant