Provider Demographics
NPI:1386030070
Name:CHAN, KHUSHALI (FNP)
Entity Type:Individual
Prefix:
First Name:KHUSHALI
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KHUSHALI
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:2801 VENETO CT
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5006
Practice Address - Country:US
Practice Address - Phone:832-724-4283
Practice Address - Fax:832-200-3636
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0315221208100000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation