Provider Demographics
NPI:1871056457
Name:AL-KHATTAB, HALIMA (PHD, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:HALIMA
Middle Name:
Last Name:AL-KHATTAB
Suffix:
Gender:F
Credentials:PHD, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11659 SINCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6030
Mailing Address - Country:US
Mailing Address - Phone:317-427-3444
Mailing Address - Fax:888-251-1412
Practice Address - Street 1:4950 W 34TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-1646
Practice Address - Country:US
Practice Address - Phone:317-721-4271
Practice Address - Fax:888-251-1412
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184191363LP0808X
IN28185255A363LP0808X
IN71009461A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300031608Medicaid