Healthcare Provider Details

I. General information

NPI: 1467980573
Provider Name (Legal Business Name): BRITTANY E KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 TRIER RD
FORT WAYNE IN
46815-5378
US

IV. Provider business mailing address

3926 NEW VISION DR
FORT WAYNE IN
46845-1712
US

V. Phone/Fax

Practice location:
  • Phone: 260-469-6603
  • Fax:
Mailing address:
  • Phone: 260-266-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28196340A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007386A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: