Provider Demographics
NPI:1285455196
Name:JEYLANI, KHADIJA MOHAMED
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:MOHAMED
Last Name:JEYLANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 BLUE RIDGE BLVD STE 611D
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1723
Mailing Address - Country:US
Mailing Address - Phone:952-261-2324
Mailing Address - Fax:
Practice Address - Street 1:4240 BLUE RIDGE BLVD STE 611D
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1723
Practice Address - Country:US
Practice Address - Phone:952-261-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023026641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty