Provider Demographics
NPI:1750523734
Name:KHAMOOSHI, SAIDA (WHNP-BC)
Entity type:Individual
Prefix:
First Name:SAIDA
Middle Name:
Last Name:KHAMOOSHI
Suffix:
Gender:F
Credentials:WHNP-BC
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6303 HARRY HINES BLVD
Practice Address - Street 2:MAPLE WOMEN'S HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5270
Practice Address - Country:US
Practice Address - Phone:214-266-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667863363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200402003Medicaid
TX200402004Medicaid
TX200402002Medicaid
TX200402001Medicaid
TX200402005Medicaid
TX200402008Medicaid
TX200402010Medicaid
TX200402007Medicaid
TX200402006Medicaid
TX200402009Medicaid
TX8Y9767OtherBLUE CROSS BLUE SHIELD