Provider Demographics
NPI:1740734326
Name:PHAM, MINH-KHUYEN (APRN)
Entity type:Individual
Prefix:
First Name:MINH-KHUYEN
Middle Name:
Last Name:PHAM
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 1:502 MEADOW VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3466
Mailing Address - Country:US
Mailing Address - Phone:817-891-4105
Mailing Address - Fax:
Practice Address - Street 1:8200 MATLOCK RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4805
Practice Address - Country:US
Practice Address - Phone:817-473-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily