Healthcare Provider Details

I. General information

NPI: 1245601988
Provider Name (Legal Business Name): KHAN PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 CHEVELLE DR
BATON ROUGE LA
70806-6503
US

IV. Provider business mailing address

778 CHEVELLE DR
BATON ROUGE LA
70806-6503
US

V. Phone/Fax

Practice location:
  • Phone: 225-995-3825
  • Fax: 504-264-5590
Mailing address:
  • Phone: 225-995-3825
  • Fax: 504-264-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAROL MCKINLEY
Title or Position: DESIGNATED AGENT
Credential: OFFICE MANAGER
Phone: 985-781-0548