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General NPI Number Information
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NPI Number | 1720543838
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Entity Type | Individual
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Provider Name | KAMAL AKHTAR FNP
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Gender | Male
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Dates
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Enumeration Date | 02/02/2019
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 300 HEALTH WAY DR
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City | POTOSI
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State | MO
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Zip | 63664-1420
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Country | US
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Telephone | 573-438-5451
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Fax |
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Provider Business Mailing Address
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Address Line | 4711 GOLF RD STE 1250
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City | SKOKIE
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State | IL
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Zip | 60076-1232
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Country | US
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Telephone | 847-235-6130
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Fax | 847-941-0577
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2019003452
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277001620
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License Number State | IL
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