Provider Demographics
NPI:1245814961
Name:NGUYEN, KATHLEEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 FRATE BARKER RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3614
Mailing Address - Country:US
Mailing Address - Phone:512-444-5627
Mailing Address - Fax:
Practice Address - Street 1:2101 FRATE BARKER RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3614
Practice Address - Country:US
Practice Address - Phone:512-444-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17397363A00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant