Provider Demographics
NPI:1700308079
Name:GREGSON, NISA NGOC DANG (APRN)
Entity Type:Individual
Prefix:
First Name:NISA
Middle Name:NGOC DANG
Last Name:GREGSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NISA
Other - Middle Name:NGOC
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:14321 STEARNS ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-7545
Mailing Address - Country:US
Mailing Address - Phone:913-449-6378
Mailing Address - Fax:
Practice Address - Street 1:6700 W 121ST ST STE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2028
Practice Address - Country:US
Practice Address - Phone:913-871-9888
Practice Address - Fax:913-871-1477
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily