Provider Demographics
NPI:1336460773
Name:KHALIL, KARRIANN LOUISE (NP)
Entity Type:Individual
Prefix:
First Name:KARRIANN
Middle Name:LOUISE
Last Name:KHALIL
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 1:9915 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1606
Mailing Address - Country:US
Mailing Address - Phone:310-843-9915
Mailing Address - Fax:310-828-8504
Practice Address - Street 1:9915 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1606
Practice Address - Country:US
Practice Address - Phone:310-843-9915
Practice Address - Fax:310-828-8504
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 19765363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner