Provider Demographics
NPI:1639843923
Name:BADESHA, HERJOT KAUR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HERJOT
Middle Name:KAUR
Last Name:BADESHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HERJOT
Other - Middle Name:KAUR
Other - Last Name:THIARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9136 IDA STREET
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953
Mailing Address - Country:US
Mailing Address - Phone:209-648-9887
Mailing Address - Fax:
Practice Address - Street 1:520 BOGUE RD SUITE E6
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-844-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty