Provider Demographics
NPI:1912475781
Name:NGUYEN, KYLA WYATT (MSN, RN, LNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:WYATT
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MSN, RN, LNP, FNP-BC
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:WYATT
Other - Last Name:LEONOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4011 GALLOWS RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1858
Mailing Address - Country:US
Mailing Address - Phone:301-919-1909
Mailing Address - Fax:
Practice Address - Street 1:6136 BRANDON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2610
Practice Address - Country:US
Practice Address - Phone:703-866-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily