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General NPI Number Information
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NPI Number | 1801988662
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Entity Type | Individual
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Provider Name | RAJ INDER KAUR KHALSA MSN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 247 DAVIS CUP DR UNIT 4239
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-8217
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Country | US
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Telephone | 505-927-4360
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2979
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-2979
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Country | US
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Telephone | 505-927-4360
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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 | 586474
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP01413
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C-APN.0001054-C-NP
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License Number State | CO
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