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NPI Code Detail

MEDICARE: MR. KHALED S QAISIEH FNP

MEDICARE:  MR. KHALED S QAISIEH  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
1363LF0000XFamily Nurse Practitioner204205LA

General Provider Information

NPI Number : 1750842100
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KHALED S QAISIEH FNP
Provider Business Mailing Address
First Line : 1012 PETROLEUM PKWY
Second Line :
City : BROUSSARD
State : LA
Zip : 70518-8020
Country : US
Telephone Number : 337-465-4600
Fax Number : 337-465-4604
Provider Business Practice Location Address
First Line : 1012 PETROLEUM PKWY
Second Line :
City : BROUSSARD
State : LA
Zip : 70518-8020
Country : US
Telephone Number : 337-465-4600
Fax Number : 337-465-4604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2019
Last Update Date : 03/28/2019

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Directions to “ MR. KHALED S QAISIEH FNP” Practice Location

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