Provider Demographics
NPI:1649459405
Name:KHAN, UZMA WAHEED (MS; RD; LD)
Entity type:Individual
Prefix:MRS
First Name:UZMA
Middle Name:WAHEED
Last Name:KHAN
Suffix:
Gender:F
Credentials:MS; RD; LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W EXCHANGE PKWY STE 2160
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7115
Mailing Address - Country:US
Mailing Address - Phone:469-471-1988
Mailing Address - Fax:866-450-9391
Practice Address - Street 1:1020 W EXCHANGE PKWY STE 2160
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7115
Practice Address - Country:US
Practice Address - Phone:469-471-1988
Practice Address - Fax:866-450-9391
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07722133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360330001Medicaid
4650462OtherMEDICARE