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General NPI Number Information
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NPI Number | 1033871462
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Entity Type | Individual
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Provider Name | KRISTIE NGUYEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 5405 S COOPER ST
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City | ARLINGTON
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State | TX
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Zip | 76017-6148
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Country | US
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Telephone | 817-465-4928
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Fax |
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Provider Business Mailing Address
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Address Line | 2376 COLLIN DR
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-0751
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Country | US
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Telephone | 972-900-4829
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15208
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License Number State | TX
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