Provider Demographics
NPI:1750329413
Name:NOUR, KHALED KAMAL (MD)
Entity type:Individual
Prefix:DR
First Name:KHALED
Middle Name:KAMAL
Last Name:NOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 4TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3736
Mailing Address - Country:US
Mailing Address - Phone:423-415-3310
Mailing Address - Fax:423-587-9898
Practice Address - Street 1:434 4TH ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3736
Practice Address - Country:US
Practice Address - Phone:423-415-3310
Practice Address - Fax:423-587-9898
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15691R207RG0100X
TNMD74372207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ105419Medicaid
LA1076244Medicaid