Healthcare Provider Details

I. General information

NPI: 1124838529
Provider Name (Legal Business Name): NGOC BAO PHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7107 DEKADINE CT
SPRING TX
77379-8063
US

IV. Provider business mailing address

7107 DEKADINE CT
SPRING TX
77379-8063
US

V. Phone/Fax

Practice location:
  • Phone: 346-370-1526
  • Fax:
Mailing address:
  • Phone: 346-370-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number830835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: