MEDICARE: MRS. KRISTA NIKIA KHALIK PMHNP-BC, MSN, RN

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5024415	NC
2	163W00000X	Registered Nurse	346030	NC
3	163W00000X	Registered Nurse	635350	NY

General Provider Information

NPI Number	:	1558663971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTA NIKIA KHALIK PMHNP-BC, MSN, RN

Provider Business Mailing Address
First Line	:	198 BROOKHAVEN DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-6282
Country	:	US
Telephone Number	:	516-661-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 BROOKHAVEN DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-6282
Country	:	US
Telephone Number	:	516-661-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	05/12/2026

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