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NPI Code Detail

MEDICARE: WARDAH KHAN NP

MEDICARE:   WARDAH  KHAN  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner22869TN

General Provider Information

NPI Number : 1063937670
Entity Type Code : Individual
Provider Name (Legal Business Name) : WARDAH KHAN NP
Provider Business Mailing Address
First Line : PO BOX 1906
Second Line :
City : MOUNT JULIET
State : TN
Zip : 37121-1906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 405 STEAM PLANT RD # 102
Second Line :
City : GALLATIN
State : TN
Zip : 37066-3027
Country : US
Telephone Number : 615-420-5390
Fax Number : 615-549-1532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2017
Last Update Date : 03/17/2018

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