Basic Information
| Provider Information | |||||||||
| NPI: | 1932116902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JALANDHARA | ||||||||
| FirstName: | NISHANT | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W CANNON ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761043029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177257900 | ||||||||
| FaxNumber: | 6822071030 | ||||||||
| Practice Location | |||||||||
| Address1: | 4420 HERITAGE TRACE PKWY STE 312 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762448904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178775858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 0435141 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 15251 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RH0005X | 0435141 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hypertension Specialist | 207RN0300X | Q5824 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1920916 | 05 | LA | MEDICAID | 352419101 | 05 | TX | MEDICAID |