Provider Demographics
NPI:1396497905
Name:TRAN, MIMI L (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:L
Last Name:TRAN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 E 29TH ST N STE 204
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2183
Mailing Address - Country:US
Mailing Address - Phone:316-500-6000
Mailing Address - Fax:
Practice Address - Street 1:9300 E 29TH ST N STE 204
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2183
Practice Address - Country:US
Practice Address - Phone:316-500-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80852-101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily