Provider Demographics
NPI:1477260818
Name:KHAN, NISHATH (FNP)
Entity Type:Individual
Prefix:
First Name:NISHATH
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 LYNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0068
Mailing Address - Country:US
Mailing Address - Phone:972-302-3639
Mailing Address - Fax:
Practice Address - Street 1:2420 LYNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-0068
Practice Address - Country:US
Practice Address - Phone:972-302-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760465163W00000X
TX1096257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse