Provider Demographics
NPI:1184065807
Name:KHAN, FURQAN (APRN ACNS-BC)
Entity type:Individual
Prefix:
First Name:FURQAN
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:APRN ACNS-BC
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN ACNS-BC
Mailing Address - Street 1:820 S MACARTHUR BLVD
Mailing Address - Street 2:SUITE#105-281
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4216
Mailing Address - Country:US
Mailing Address - Phone:972-584-7616
Mailing Address - Fax:214-853-5364
Practice Address - Street 1:1420 VALWOOD PKWY STE NO170
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-8312
Practice Address - Country:US
Practice Address - Phone:972-584-7616
Practice Address - Fax:214-853-5364
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122466364SA2200X
TX696580364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328757YV9ZMedicare PIN