Provider Demographics
NPI:1508101486
Name:KHAN, NASIRA HUSSAIN (PA-C)
Entity Type:Individual
Prefix:
First Name:NASIRA
Middle Name:HUSSAIN
Last Name:KHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 LAKE BEND TRL
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7822
Mailing Address - Country:US
Mailing Address - Phone:682-472-4678
Mailing Address - Fax:
Practice Address - Street 1:4819 RIVER OAKS BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-3098
Practice Address - Country:US
Practice Address - Phone:817-626-9744
Practice Address - Fax:817-626-9962
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07883363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical