Healthcare Provider Details

I. General information

NPI: 1376092155
Provider Name (Legal Business Name): THUY T TRAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 01/29/2024
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 SECURITY SQ
GULFPORT MS
39507-1922
US

IV. Provider business mailing address

PO BOX 7020
SLIDELL LA
70469-7020
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-4575
  • Fax: 833-222-4520
Mailing address:
  • Phone: 985-643-4575
  • Fax: 833-222-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number303834
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: