Provider Demographics
NPI:1750989810
Name:NGUYEN, TRANG KHANH (NP-C)
Entity type:Individual
Prefix:
First Name:TRANG
Middle Name:KHANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-0925
Mailing Address - Country:US
Mailing Address - Phone:706-854-6008
Mailing Address - Fax:706-854-6946
Practice Address - Street 1:2258 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4887
Practice Address - Country:US
Practice Address - Phone:706-724-4400
Practice Address - Fax:706-724-6003
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN246685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily