Individual provider Active NPI

Elizabeth Maratovna Khavkina, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Panorama City, CA
National Provider Identifier
1073376612
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95037175 Issued in CA
Practice address
14860 Roscoe Blvd Ste 307
Panorama City, CA 91402-4691
Phone
(818) 616-2122
NPI assigned
Feb 6, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95037175 CA Primary
Registered Nurse 163W00000X 95311194 CA

Addresses

Primary practice location

14860 Roscoe Blvd Ste 307
Panorama City, CA 91402-4691

Mailing address

11901 Louise Ave
Granada Hills, CA 91344-2449
Phone (323) 717-9626

Other practice location 1

20301 Ventura Blvd Ste 202
Woodland Hills, CA 91364-0923
Phone (323) 717-9626

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
95311194CAMDRegistered Nurse
95037175CAMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779235200000",
    "number": "1073376612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11901 LOUISE AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913442449",
            "telephone_number": "323-717-9626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14860 ROSCOE BLVD STE 307",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914024691",
            "telephone_number": "818-616-2122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20301 Ventura Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Woodland Hills",
            "state": "CA",
            "postal_code": "913640923",
            "country_code": "US",
            "telephone_number": "323-717-9626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAVKINA",
        "first_name": "ELIZABETH",
        "middle_name": "MARATOVNA",
        "name_prefix": "Miss",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-06",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95037175",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95311194",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panorama City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.