Provider Demographics
NPI:1063918449
Name:NGUYEN, NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S MAIN ST STE 191
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7548
Mailing Address - Country:US
Mailing Address - Phone:210-201-2241
Mailing Address - Fax:210-756-5125
Practice Address - Street 1:940 S MAIN ST
Practice Address - Street 2:STE 191
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:210-201-2241
Practice Address - Fax:210-756-5125
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-01-17
Deactivation Date:2021-04-09
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
TXT51792084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry