Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | E-14434 | AR |
N | 111NI0900X | Internist | E-14434 | AR |
Y | 207RG0300X | Geriatric Medicine | E-14434 | AR |
NPI | 1013339266 |
---|---|
Provider Name | Fatima Khan |
First Address | Little Rock, AR 72225-1420 |
Second Address | Little Rock, AR 72205-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2014 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1F7843 | MEDICARE (01) | TX |