Provider Demographics
NPI:1982267027
Name:KOSHY, NISHANT ABRAHAM
Entity type:Individual
Prefix:
First Name:NISHANT
Middle Name:ABRAHAM
Last Name:KOSHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 GALLAGHER DR STE D
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1754
Mailing Address - Country:US
Mailing Address - Phone:903-771-2846
Mailing Address - Fax:
Practice Address - Street 1:809 GALLAGHER DR STE D
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1754
Practice Address - Country:US
Practice Address - Phone:903-771-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT7621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty