Healthcare Provider Details

I. General information

NPI: 1861942708
Provider Name (Legal Business Name): JED DINH NGUYEN MS, APRN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 N WHISENANT DR
DUNCAN OK
73533-1650
US

IV. Provider business mailing address

1809 TERRACE DR
DUNCAN OK
73533-1327
US

V. Phone/Fax

Practice location:
  • Phone: 580-252-5300
  • Fax: 580-251-8575
Mailing address:
  • Phone: 405-615-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number93835
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: