Provider Demographics
NPI:1215611314
Name:PHAM, DEBBIE NHUNG (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:NHUNG
Last Name:PHAM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 LOWES FARM PKWY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8616
Mailing Address - Country:US
Mailing Address - Phone:817-455-3385
Mailing Address - Fax:
Practice Address - Street 1:7520 N BEACH ST STE 108
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1507
Practice Address - Country:US
Practice Address - Phone:817-984-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily