Provider Demographics
NPI:1568926335
Name:NGUYEN, THEA (FNP)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 RUFE SNOW DR STE 132
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5691
Mailing Address - Country:US
Mailing Address - Phone:817-576-4050
Mailing Address - Fax:
Practice Address - Street 1:4630 LONG PRAIRIE RD STE 210
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1964
Practice Address - Country:US
Practice Address - Phone:469-495-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner