Provider Demographics
NPI:1811055361
Name:KHAN, KHURUM ABBAS (FNP)
Entity type:Individual
Prefix:MR
First Name:KHURUM
Middle Name:ABBAS
Last Name:KHAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GRANVILLE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5709
Mailing Address - Country:US
Mailing Address - Phone:336-716-8675
Mailing Address - Fax:336-716-5414
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1191
Practice Address - Country:US
Practice Address - Phone:336-716-8675
Practice Address - Fax:336-716-5414
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0002-01942363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0002-01942OtherMEDICAL STATE LICENSE
NC150144OtherNURSING LICENSE