Healthcare Provider Details

I. General information

NPI: 1740009158
Provider Name (Legal Business Name): KATHLEEN THAM NGUYEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 E MAYFIELD RD STE 115
ARLINGTON TX
76014-2605
US

IV. Provider business mailing address

13840 BIRCHLAWN DR
DALLAS TX
75234-3514
US

V. Phone/Fax

Practice location:
  • Phone: 682-276-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024003800
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number896649
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: