Active NPI
Khadijeh Al-Abedalla
- Student in an Organized Health Care Education/Training Program
- Farmington, CT
National Provider Identifier
1063860294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 11977
- Practice address
- 263 Farmington Ave
Farmington, CT 06030-0001 - Phone
- (860) 679-2000
- NPI assigned
- May 27, 2016
- Last updated
- Mar 12, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 11977 | CT | Primary |
Addresses
Primary practice location
263 Farmington Ave
Farmington, CT 06030-0001
Mailing address
2524 NW 162ND Terrace
Edmond, OK 73013-0000
Phone (405) 413-5603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160920001822 | CT | Order and Referring Only - Other (Physician) | 5698062560 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11977 | CT | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552348800000",
"number": "1063860294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2524 NW 162ND TERRACE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730130000",
"telephone_number": "405-413-5603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "263 FARMINGTON AVE",
"city": "FARMINGTON",
"state": "CT",
"postal_code": "060300001",
"telephone_number": "860-679-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AL-ABEDALLA",
"first_name": "KHADIJEH",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-27",
"last_updated": "2019-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CT",
"license": "11977",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.