Healthcare Provider Details

I. General information

NPI: 1932583291
Provider Name (Legal Business Name): OANH NGUYEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKIE NGUYEN

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 WILLIAMS BLVD SUITE #100
KENNER LA
70065-3075
US

IV. Provider business mailing address

2104 GAUSE BLVD W SUITE A
SLIDELL LA
70460-4130
US

V. Phone/Fax

Practice location:
  • Phone: 504-464-4550
  • Fax: 504-465-8590
Mailing address:
  • Phone: 985-643-4575
  • Fax: 504-643-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.200859
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200859
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: