Provider Demographics
NPI:1487824322
Name:KHAN, JENNY R (FNP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:KHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:SCHMIDT
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:4530 E MUIRWOOD DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7693
Mailing Address - Country:US
Mailing Address - Phone:480-961-2307
Mailing Address - Fax:480-961-0419
Practice Address - Street 1:4530 E MUIRWOOD DR STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7693
Practice Address - Country:US
Practice Address - Phone:480-961-2307
Practice Address - Fax:480-961-0419
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ494896Medicaid