Individual provider Active NPI

Khadijah Adel Hassan Mahmoud Moustafa

  • Student in an Organized Health Care Education/Training Program
  • Little Rock, AR
National Provider Identifier
1730062688
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
4301 W Markham St # 517
Little Rock, AR 72205-7101
Phone
(501) 603-1508
NPI assigned
Jul 29, 2025
Last updated
Jul 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

4301 W Markham St # 517
Little Rock, AR 72205-7101

Mailing address

518 E 7TH St Apt 1
Little Rock, AR 72202-2549
Phone (501) 644-9968

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251016004336 AR Order and Referring Only - PathologyPractitioner - Pathology 0749777274

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1730062688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 E 7TH ST APT 1",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722022549",
            "telephone_number": "501-644-9968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 517",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-603-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUSTAFA",
        "first_name": "KHADIJAH",
        "middle_name": "ADEL HASSAN MAHMOUD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.