Healthcare Provider Details

I. General information

NPI: 1992269674
Provider Name (Legal Business Name): PHILLIP PHU NGUYEN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 NEW COVINGTON PIKE
MEMPHIS TN
38128-2504
US

IV. Provider business mailing address

369 LIDA LN
CORDOVA TN
38018-1021
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-5741
  • Fax: 901-516-5986
Mailing address:
  • Phone: 901-336-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25341
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: