Provider Demographics
NPI:1316819089
Name:KANG, NICOLE SUERIN (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUERIN
Last Name:KANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12228 N CENTRAL EXPY STE 410
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3797
Mailing Address - Country:US
Mailing Address - Phone:972-566-5255
Mailing Address - Fax:972-566-5236
Practice Address - Street 1:12228 N CENTRAL EXPY STE 410
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3797
Practice Address - Country:US
Practice Address - Phone:972-566-5255
Practice Address - Fax:972-566-5236
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical