MEDICARE: MS. LETICIA KHOSAMA A.N.P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	725588	TX
2	363L00000X	Nurse Practitioner	AP122206	TX

General Provider Information

NPI Number	:	1063768737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LETICIA KHOSAMA A.N.P

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-8852
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6303 FOREST PARK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-5450
Country	:	US
Telephone Number	:	214-648-7401
Fax Number	:	214-648-1955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	06/07/2023

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