Provider Demographics
NPI:1841584596
Name:OUTLAW, KHALIDA (RN)
Entity Type:Individual
Prefix:MS
First Name:KHALIDA
Middle Name:
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-0491
Mailing Address - Country:US
Mailing Address - Phone:646-279-4521
Mailing Address - Fax:
Practice Address - Street 1:50 E.168TH ST.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-7929
Practice Address - Country:US
Practice Address - Phone:917-862-5215
Practice Address - Fax:718-347-4643
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-29
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295252164W00000X
NY810664163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No164W00000XNursing Service ProvidersLicensed Practical Nurse