Provider Demographics
NPI:1871219204
Name:GILL, PRABHDEEP (PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:PRABHDEEP
Middle Name:
Last Name:GILL
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6364 N FIGARDEN DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-7943
Mailing Address - Country:US
Mailing Address - Phone:559-304-8227
Mailing Address - Fax:559-238-0118
Practice Address - Street 1:6364 N FIGARDEN DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-7981
Practice Address - Country:US
Practice Address - Phone:559-304-8227
Practice Address - Fax:559-238-0118
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019846363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily