Provider Demographics
NPI:1093285629
Name:BAINS, NIMRAT (PA)
Entity type:Individual
Prefix:
First Name:NIMRAT
Middle Name:
Last Name:BAINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WYNDHAM KNOB
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-9431
Mailing Address - Country:US
Mailing Address - Phone:315-420-9983
Mailing Address - Fax:
Practice Address - Street 1:803 FARSON ST STE 100
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-0016
Practice Address - Country:US
Practice Address - Phone:740-423-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005784RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0325737Medicaid