Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 1060344 | TX |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 1060344 | TX |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 1060344 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1060344 | TX |
NPI | 1063170066 |
---|---|
Provider Name | Miss Khadijah Hafsa Bah |
First Address | Forney, TX 75126-4169 |
Second Address | Forney, TX 75126-4169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2021 |
Last Update Date | 07/12/2021 |