Provider Demographics
NPI:1518087865
Name:TRAN, NHANHIEN D (PA-C)
Entity Type:Individual
Prefix:
First Name:NHANHIEN
Middle Name:D
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-2305
Mailing Address - Country:US
Mailing Address - Phone:316-516-4895
Mailing Address - Fax:
Practice Address - Street 1:1317 S DEWEY AVE
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-7013
Practice Address - Country:US
Practice Address - Phone:918-485-9696
Practice Address - Fax:918-485-1701
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501107363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200739590AMedicaid
110990040OtherMEDICARE (VIA CHRIST)
OKOKB0019OtherMEDICARE GROUP PTAN
110990040OtherMEDICARE (VIA CHRIST)
OKOKB0019OtherMEDICARE GROUP PTAN
KS200739590AMedicaid