Provider Demographics
NPI:1619487907
Name:NGUYEN, KIMBERLY THAO (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:THAO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 LYNDON B JOHNSON FWY STE 114
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4635
Mailing Address - Country:US
Mailing Address - Phone:214-557-4111
Mailing Address - Fax:214-764-7611
Practice Address - Street 1:9441 LYNDON B JOHNSON FWY STE 114
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4635
Practice Address - Country:US
Practice Address - Phone:214-557-4111
Practice Address - Fax:214-764-7611
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily