Provider Demographics
NPI:1154916724
Name:BATHINI, KAVITHA (APN)
Entity type:Individual
Prefix:MRS
First Name:KAVITHA
Middle Name:
Last Name:BATHINI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2081
Mailing Address - Country:US
Mailing Address - Phone:415-609-4254
Mailing Address - Fax:
Practice Address - Street 1:607 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2081
Practice Address - Country:US
Practice Address - Phone:415-609-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01121300363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology