MEDICARE: NICKHAT AHMED FNP

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	363LF0000X	Family Nurse Practitioner	95015280	CA
2	163WM0705X	Medical-Surgical Registered Nurse	793092	CA
3	163W00000X	Registered Nurse	793092	CA

General Provider Information

NPI Number	:	1669004578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKHAT AHMED FNP

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	24221 CALLE DE LA LOUISA STE 400
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-7632
Country	:	US
Telephone Number	:	949-770-2085
Fax Number	:

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

Provider Enumeration Date	:	02/08/2020
Last Update Date	:	11/12/2025

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