MEDICARE: MR. NGHIA TRONG NGUYEN MSN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2018008253	MO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	78009	KS

General Provider Information

NPI Number	:	1265932982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NGHIA TRONG NGUYEN MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	2900 CLAY EDWARDS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3235
Country	:	US
Telephone Number	:	816-691-5101
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 CLAY EDWARDS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3235
Country	:	US
Telephone Number	:	816-691-5101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	04/17/2018

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