Provider Demographics
NPI:1861491847
Name:NGUYEN, NICK (DC, NP-C)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC, NP-C
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:CONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC, NP-C
Mailing Address - Street 1:2510 SMITH RANCH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5209
Mailing Address - Country:US
Mailing Address - Phone:713-340-3111
Mailing Address - Fax:
Practice Address - Street 1:12121 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5208
Practice Address - Country:US
Practice Address - Phone:281-955-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX777198363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297696101Medicaid
TXTXB149788OtherMEDICARE