Provider Demographics
NPI:1104661735
Name:KHAMIS, NESTAZIA (PA-C)
Entity type:Individual
Prefix:
First Name:NESTAZIA
Middle Name:
Last Name:KHAMIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10750 W WHITEHORN WAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-9799
Mailing Address - Country:US
Mailing Address - Phone:623-256-4780
Mailing Address - Fax:
Practice Address - Street 1:10750 W WHITEHORN WAY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-9799
Practice Address - Country:US
Practice Address - Phone:623-256-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant