MEDICARE: KELLY PATE NGUYEN NP

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	363L00000X	Nurse Practitioner	201652	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801091343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY PATE NGUYEN NP

Provider Business Mailing Address
First Line	:	1110 SE CARY PKWY
Second Line	:	SUITE 206
City	:	CARY
State	:	NC
Zip	:	27518-7420
Country	:	US
Telephone Number	:	919-463-1101
Fax Number	:	919-463-1110

Provider Business Practice Location Address
First Line	:	1110 SE CARY PKWY
Second Line	:	SUITE 206
City	:	CARY
State	:	NC
Zip	:	27518-7420
Country	:	US
Telephone Number	:	919-463-1101
Fax Number	:	919-463-1110

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	04/14/2015

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