Basic Information
Provider Information
NPI: 1558989301
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: REEMA
MiddleName: BHUPEN
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2400 PATTERSON ST STE 400
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372031575
CountryCode: US
TelephoneNumber: 6153425900
FaxNumber:  
Practice Location
Address1: 2400 PATTERSON ST STE 400
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372031575
CountryCode: US
TelephoneNumber: 6153425900
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/08/2020
LastUpdateDate: 11/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X4073TNY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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