Ali, Khalillah S

Ali, Khalillah S is an sole proprietor health care provider with primary practice located at 455 Gotland Dr , Grand Prairie TX 75052-2570. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Holistic, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Ali, Khalillah S can be contacted via phone (469) 831-3149.

Contact Information

Primary practice address
455 Gotland Dr Grand Prairie TX 75052-2570
Phone: (469) 831-3149
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Holistic 364SH1100X AP113331 Texas
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 682811 Texas

Profile Details

NPI number 1972521417
LBN Legal business name Ali, Khalillah S
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 17th, 2006
Last updated Sep 27th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972521417 NPPES
Texas MEDICAID 170329003

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