Provider Demographics
NPI:1063979003
Name:DEVKOTA, KANTI (FNP)
Entity type:Individual
Prefix:
First Name:KANTI
Middle Name:
Last Name:DEVKOTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 PRAIRIE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4867
Mailing Address - Country:US
Mailing Address - Phone:307-778-3121
Mailing Address - Fax:
Practice Address - Street 1:1331 PRAIRIE AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4867
Practice Address - Country:US
Practice Address - Phone:307-778-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner