Provider Demographics
NPI:1992252266
Name:ABDUL, KHABEER
Entity type:Individual
Prefix:
First Name:KHABEER
Middle Name:
Last Name:ABDUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 W STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-8137
Mailing Address - Country:US
Mailing Address - Phone:270-432-4800
Mailing Address - Fax:270-432-4804
Practice Address - Street 1:1704 W STOCKTON ST
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8137
Practice Address - Country:US
Practice Address - Phone:270-432-4800
Practice Address - Fax:270-432-4804
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-05
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN189364163W00000X
KS81327363L00000X
TXAP133118363L00000X
TN21562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner