Basic Information
| Provider Information | |||||||||
| NPI: | 1124167440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KODANDAPANI | ||||||||
| FirstName: | KESHAVAN | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 W. CHARLESTON BLVD. | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832688 | ||||||||
| FaxNumber: | 7029523364 | ||||||||
| Practice Location | |||||||||
| Address1: | 5757 WAYNE NEWTON BLVD. | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832527 | ||||||||
| FaxNumber: | 7023831991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | APN000923 | NV | N | Nursing Service Providers | Licensed Practical Nurse | 363L00000X | APRN000923 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.