Provider Demographics
NPI:1336983006
Name:BHATTARAI, KANCHAN (AANP)
Entity type:Individual
Prefix:
First Name:KANCHAN
Middle Name:
Last Name:BHATTARAI
Suffix:
Gender:F
Credentials:AANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W NIFONG BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4469
Mailing Address - Country:US
Mailing Address - Phone:573-815-6640
Mailing Address - Fax:573-815-6644
Practice Address - Street 1:900 W NIFONG BLVD STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4469
Practice Address - Country:US
Practice Address - Phone:573-815-6640
Practice Address - Fax:573-815-6644
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024023417363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care