Provider Demographics
NPI:1811461197
Name:KHAMSI, MOHAMED ABDOULLAH (AG-ACNP)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDOULLAH
Last Name:KHAMSI
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TRANS MOUNTAIN RD STE B400
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3601
Mailing Address - Country:US
Mailing Address - Phone:915-215-8400
Mailing Address - Fax:
Practice Address - Street 1:2000 TRANSMOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3601
Practice Address - Country:US
Practice Address - Phone:915-215-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140232363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care