Provider Demographics
NPI:1134896780
Name:NGUYEN, KHANG (SRNA, RN)
Entity type:Individual
Prefix:
First Name:KHANG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:SRNA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 ADELMONT CT
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3621
Mailing Address - Country:US
Mailing Address - Phone:404-422-5612
Mailing Address - Fax:
Practice Address - Street 1:1706 ADELMONT CT
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3621
Practice Address - Country:US
Practice Address - Phone:404-422-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse