Provider Demographics
NPI:1003102625
Name:KHAN, KAYLYN MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:MARIE
Last Name:KHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-5671
Mailing Address - Country:US
Mailing Address - Phone:850-785-9511
Mailing Address - Fax:850-763-9494
Practice Address - Street 1:3808 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-5671
Practice Address - Country:US
Practice Address - Phone:850-785-9511
Practice Address - Fax:850-763-9494
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9278929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily