Provider Demographics
NPI:1245503986
Name:PHAN, LOAN KIM (APRN)
Entity type:Individual
Prefix:MS
First Name:LOAN
Middle Name:KIM
Last Name:PHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3718
Mailing Address - Country:US
Mailing Address - Phone:316-554-2126
Mailing Address - Fax:316-554-2128
Practice Address - Street 1:1624 N ROCK RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3718
Practice Address - Country:US
Practice Address - Phone:316-554-2126
Practice Address - Fax:316-554-2128
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75552-102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily