Provider Demographics
NPI:1801988662
Name:KHALSA, RAJ INDER KAUR (MSN)
Entity type:Individual
Prefix:
First Name:RAJ INDER
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:MSN
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 2979
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-2979
Mailing Address - Country:US
Mailing Address - Phone:505-927-4360
Mailing Address - Fax:
Practice Address - Street 1:247 DAVIS CUP DR UNIT 4239
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8217
Practice Address - Country:US
Practice Address - Phone:505-927-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX586474363LF0000X
NMCNP01413363LF0000X
COC-APN.0001054-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP93452Medicare UPIN