Provider Demographics
NPI:1285435057
Name:SAYAVONG, HUONG TIEC (NP)
Entity type:Individual
Prefix:
First Name:HUONG
Middle Name:TIEC
Last Name:SAYAVONG
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MELSTONE CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8807
Mailing Address - Country:US
Mailing Address - Phone:469-226-3875
Mailing Address - Fax:
Practice Address - Street 1:115 PARK PLACE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-9210
Practice Address - Country:US
Practice Address - Phone:469-466-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1192935363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care