Provider Demographics
NPI:1548569163
Name:NGUYEN, THUY-TRANG THI (MD)
Entity Type:Individual
Prefix:
First Name:THUY-TRANG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504938
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4938
Mailing Address - Country:US
Mailing Address - Phone:816-932-1711
Mailing Address - Fax:816-932-1719
Practice Address - Street 1:4400 BROADWAY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-932-1711
Practice Address - Fax:816-932-1719
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150131742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1548569163Medicaid
MO970613273Medicare PIN