Provider Demographics
NPI:1205137569
Name:MOHAMMADKHAH, LIDA (ANP)
Entity type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:
Last Name:MOHAMMADKHAH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 SYDNEY LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8153
Mailing Address - Country:US
Mailing Address - Phone:615-969-7278
Mailing Address - Fax:
Practice Address - Street 1:530 GREAT CIRCLE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1309
Practice Address - Country:US
Practice Address - Phone:312-262-2739
Practice Address - Fax:312-564-4059
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN94637363LF0000X
TN15233363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily