Individual ProviderKhadija Bilali-AzzatNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address801 S Rancho Dr Ste B2, Las Vegas, NV 89106-3860(752) 217-5628PECOS EnrollmentBased on the most recent information from CMS, provider Khadija Bilali-Azzat is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1962114843Provider TypeIndividualFull NameBilali-Azzat, KhadijaCredentialNURSE PRACTITIONERGenderFemaleSole ProprietorYesEnumeration Date12/22/2022Last Updated12/22/2022Contact InformationPractice LocationPractice Address801 S Rancho Dr Ste B2, Las Vegas, NV 89106-3860Phone(752) 217-5628Fax(702) 331-2035Mailing LocationMailing Address801 S Rancho Dr Ste B2, Las Vegas, NV 89106-3860Phone(752) 217-5628Fax(702) 331-2035Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense861921Nevada