MEDICARE: KATHERINE KHEN ZAMA MBUH FNP

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	363LF0000X	Family Nurse Practitioner	AP132859	TX

General Provider Information

NPI Number	:	1568907202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE KHEN ZAMA MBUH FNP

Provider Business Mailing Address
First Line	:	648 E BUTLER ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-5523
Country	:	US
Telephone Number	:	817-382-0005
Fax Number	:	682-334-7238

Provider Business Practice Location Address
First Line	:	4759 SOUTH FWY STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-3655
Country	:	US
Telephone Number	:	817-382-0005
Fax Number	:	682-334-7238

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

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	05/08/2026

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