Provider Demographics
NPI:1164247672
Name:KHAN, AMBREEN JESSICA (NP)
Entity type:Individual
Prefix:
First Name:AMBREEN
Middle Name:JESSICA
Last Name:KHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 HORIZONS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9575
Mailing Address - Country:US
Mailing Address - Phone:650-436-9922
Mailing Address - Fax:
Practice Address - Street 1:7035 N MAPLE AVE STE 102A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8026
Practice Address - Country:US
Practice Address - Phone:559-299-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily