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General NPI Number Information
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NPI Number | 1598556094
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Entity Type | Individual
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Provider Name | KHELIN VIRAK FNP-BC/FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 250 E PONCE DE LEON AVE
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City | DECATUR
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State | GA
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Zip | 30030-3440
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Country | US
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Telephone | 404-727-7980
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Fax |
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Provider Business Mailing Address
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Address Line | 530 PIEDMONT AVE NE APT 608
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City | ATLANTA
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State | GA
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Zip | 30308-4409
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Country | US
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Telephone | 207-415-5955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN324425
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License Number State | GA
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