Healthcare Provider Details

I. General information

NPI: 1447947205
Provider Name (Legal Business Name): CHRISTINA NGOC NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 02/07/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 WILSON ST
LAWTON OK
73503
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905-5650
US

V. Phone/Fax

Practice location:
  • Phone: 857-321-1144
  • Fax:
Mailing address:
  • Phone:
  • Fax: 706-787-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1221544
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: