Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9278929 | FL |
NPI | 1003102625 |
---|---|
Provider Name | Kaylyn Marie Khan |
First Address | Panama City, FL 32401-5671 |
Second Address | Panama City, FL 32401-5671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 09/07/2013 |