Aisha Javed Khan, MCN, RD, LD
Individual provider Active NPI Registered Dietitian · Lavon, TX
NPI 1992579619 · NPPES record last updated Nov 13, 2023
Key facts
- NPI
- 1992579619
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DT89153 (TX)
- Practice address
- 358 Brookstone Dr
Lavon, TX 75166-4747 - Phone
- (469) 442-6099
- NPI assigned
- Nov 13, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- University of Texas Southwestern Medical School at Dallas, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Reshaped PLLC
Practice addresses (Care Compare)
2008 E Hebron Pkwy
Suite 114
Carrollton, TX 75007-1601
Phone (469) 431-0544
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231213002401 | TX | Practitioner - Registered Dietitian Or Nutrition Professional | 9537518725 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT89153 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reshaped PLLC | Current |
Accepting new patients |
Locations
2008 E Hebron Pkwy
Ste 114
Carrollton, TX 75007
Phone (469) 431-0544
Interoperability endpoints
- aisha.khan.1@19284.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT89153 | TX | Yes |
Addresses
Primary practice location
358 Brookstone Dr
Lavon, TX 75166-4747
Mailing address
358 Brookstone Dr
Lavon, TX 75166-4747
Phone (469) 442-6099
Other providers in Lavon, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.