Provider Demographics
NPI:1558968552
Name:GUPTA, KHUSBU DESAI (NP)
Entity type:Individual
Prefix:
First Name:KHUSBU
Middle Name:DESAI
Last Name:GUPTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 DEBERRY HOLW
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7639
Mailing Address - Country:US
Mailing Address - Phone:864-208-7205
Mailing Address - Fax:
Practice Address - Street 1:196 CARDIOLOGY DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1174
Practice Address - Country:US
Practice Address - Phone:803-324-5135
Practice Address - Fax:803-324-8161
Is Sole Proprietor?:No
Enumeration Date:2020-10-03
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily