Provider Demographics
NPI:1053871566
Name:KATHURIA-PRAKASH, NIKHITA (MD)
Entity type:Individual
Prefix:DR
First Name:NIKHITA
Middle Name:
Last Name:KATHURIA-PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIKHITA
Other - Middle Name:
Other - Last Name:KATHURIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:795 SW STATE ROAD 47
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0453
Practice Address - Country:US
Practice Address - Phone:386-401-7066
Practice Address - Fax:833-933-0709
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME171404207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL126538100Medicaid