Provider Demographics
NPI:1629466859
Name:DUONG, TAM T (APRN)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:T
Last Name:DUONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-899-4177
Mailing Address - Fax:502-259-6336
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-899-4177
Practice Address - Fax:502-259-6900
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3009032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01532301OtherRAILROAD MEDICARE (KOHMG)
KY7100370670Medicaid
KYP01532301OtherRAILROAD MEDICARE (KOHMG)