Provider Demographics
NPI:1962391672
Name:KHOUDEDA, ASIA KEJJAN
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:KEJJAN
Last Name:KHOUDEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2204
Mailing Address - Country:US
Mailing Address - Phone:402-318-9559
Mailing Address - Fax:
Practice Address - Street 1:215 BRUCE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2204
Practice Address - Country:US
Practice Address - Phone:402-318-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care