Provider Demographics
NPI:1508578428
Name:KHAN, ELIZABETH ZALENA I (NP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ZALENA
Last Name:KHAN
Suffix:I
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ZALENA
Other - Last Name:KHAN
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4203 S CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3203
Mailing Address - Country:US
Mailing Address - Phone:972-642-3910
Mailing Address - Fax:
Practice Address - Street 1:4203 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3203
Practice Address - Country:US
Practice Address - Phone:972-642-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1102991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily