Healthcare Provider Details

I. General information

NPI: 1164014981
Provider Name (Legal Business Name): TRAN NGUYEN PHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRAN NGUYEN HUYNH

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROBERT BLVD
SLIDELL LA
70458-1667
US

IV. Provider business mailing address

2900 INDIANA AVE
KENNER LA
70065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 866-530-6111
  • Fax:
Mailing address:
  • Phone: 504-575-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218396
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: