MEDICARE: JOHNNY NGUYEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP134491	TX

General Provider Information

NPI Number	:	1245753532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY NGUYEN

Provider Business Mailing Address
First Line	:	720 W 11TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-6714
Country	:	US
Telephone Number	:	713-880-5266
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 W 11TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-6714
Country	:	US
Telephone Number	:	713-880-5266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	04/10/2019

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Directions to “ JOHNNY NGUYEN ” Practice Location

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