Healthcare Provider Details

I. General information

NPI: 1912475781
Provider Name (Legal Business Name): KYLA WYATT NGUYEN MSN, RN, LNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYLA WYATT LEONOR

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6136 BRANDON AVE
SPRINGFIELD VA
22150-2610
US

IV. Provider business mailing address

4011 GALLOWS RD
ANNANDALE VA
22003-1858
US

V. Phone/Fax

Practice location:
  • Phone: 703-866-3131
  • Fax:
Mailing address:
  • Phone: 301-919-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176891
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: