Healthcare Provider Details

I. General information

NPI: 1750084430
Provider Name (Legal Business Name): CHRISTINE HUYEN NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 BROADWAY BLVD
KANSAS CITY MO
64111-2501
US

IV. Provider business mailing address

3515 BROADWAY BLVD
KANSAS CITY MO
64111-2501
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-5144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2016042000
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023011555
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: