Healthcare Provider Details

I. General information

NPI: 1710791744
Provider Name (Legal Business Name): KATHLEEN TRINH VUONG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N BELL BLVD STE 100
CEDAR PARK TX
78613-2216
US

IV. Provider business mailing address

9304 CLEAROCK DR
AUSTIN TX
78750-2731
US

V. Phone/Fax

Practice location:
  • Phone: 737-321-0200
  • Fax: 737-321-0201
Mailing address:
  • Phone: 512-801-9978
  • Fax: 512-519-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1140667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: