Provider Demographics
NPI:1407672876
Name:KHAMBAY, ALLISON (FNP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KHAMBAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N CHURCH ST UNIT 313
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2295
Mailing Address - Country:US
Mailing Address - Phone:980-875-0130
Mailing Address - Fax:
Practice Address - Street 1:715 N CHURCH ST UNIT 313
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2295
Practice Address - Country:US
Practice Address - Phone:980-875-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF10220712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner