MEDICARE: PHUONG KIM THI NGUYEN RUXTON R.N., FNP

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	721719	TX

General Provider Information

NPI Number	:	1770908121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG KIM THI NGUYEN RUXTON R.N., FNP

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-9134
Country	:	US
Telephone Number	:	214-645-1814
Fax Number	:	214-645-3376

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-1759
Country	:	US
Telephone Number	:	214-645-1814
Fax Number	:	214-645-3376

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

Provider Enumeration Date	:	02/21/2014
Last Update Date	:	07/25/2023

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