Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 731144 | TX |
NPI | 1063833754 |
---|---|
Provider Name | Jenny Khan |
First Address | Houston, TX 77268-0608 |
Second Address | Conroe, TX 77304-3317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2013 |
Last Update Date | 23/12/2013 |