Provider Demographics
NPI:1205467578
Name:TRAN, TINA THANH THUY (PA-C)
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:THANH THUY
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5100 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2739
Mailing Address - Country:US
Mailing Address - Phone:316-992-3487
Mailing Address - Fax:
Practice Address - Street 1:19101 E VALLEY VIEW PKWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6904
Practice Address - Country:US
Practice Address - Phone:816-254-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021028686363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical