Provider Demographics
NPI:1801436431
Name:MOUA, PANG CHENG (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:PANG
Middle Name:CHENG
Last Name:MOUA
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12802 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1645
Mailing Address - Country:US
Mailing Address - Phone:913-962-7600
Mailing Address - Fax:
Practice Address - Street 1:12802 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1645
Practice Address - Country:US
Practice Address - Phone:913-962-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily