| Doctor Name: | KHANKHAM KAITLYN SENESOURY |
| NPI Number: | 1225406440 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | AP128938 |
| Business Practice Address: | 3101 Denton Hwy Haltom City, TX - 761173706 |
| Business Phone Number: | 8178316500 |
| Business Fax Number: | |
| Mailing Address: | 1200 W Walnut Hill Ln, Ste. 3950 IRVING |
| State: | TX |
| Postal Code: | 750383029 |
| Phone Number: | 9725141672 |
| Fax Number: | |
| NPI Enumeration Date: | 09/03/2015 |
| NPI Last Update Date: | 09/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP128938 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |