Healthcare Provider Details

I. General information

NPI: 1861109548
Provider Name (Legal Business Name): EMILY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S PRESTON RD STE 30
PROSPER TX
75078-3070
US

IV. Provider business mailing address

210 S PRESTON RD STE 30
PROSPER TX
75078-3070
US

V. Phone/Fax

Practice location:
  • Phone: 972-408-4410
  • Fax: 972-408-4411
Mailing address:
  • Phone: 972-408-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20529
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: