Healthcare Provider Details

I. General information

NPI: 1053225946
Provider Name (Legal Business Name): AZEEM A KHAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PRINCE WILLIAM RD STE A
DELPHI IN
46923-1759
US

IV. Provider business mailing address

8820 VILLAGE GROVE DR
FORT WAYNE IN
46804-2645
US

V. Phone/Fax

Practice location:
  • Phone: 765-564-6757
  • Fax:
Mailing address:
  • Phone: 914-882-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08260133
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: