Provider Demographics
NPI:1659642973
Name:PREJEAN, KHATSAYA
Entity Type:Individual
Prefix:
First Name:KHATSAYA
Middle Name:
Last Name:PREJEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E PRATER WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8969
Mailing Address - Country:US
Mailing Address - Phone:775-722-7769
Mailing Address - Fax:775-358-6843
Practice Address - Street 1:1625 E PRATER WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8969
Practice Address - Country:US
Practice Address - Phone:775-722-7769
Practice Address - Fax:775-358-6843
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist