Provider Demographics
NPI:1780260919
Name:QADAH, ABDALHAKIM (FNP-C)
Entity type:Individual
Prefix:
First Name:ABDALHAKIM
Middle Name:
Last Name:QADAH
Suffix:
Gender:M
Credentials:FNP-C
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 6749
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0749
Mailing Address - Country:US
Mailing Address - Phone:502-767-8507
Mailing Address - Fax:
Practice Address - Street 1:3792 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1737
Practice Address - Country:US
Practice Address - Phone:859-457-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily