Provider Demographics
NPI:1356146336
Name:LE, PHU BA (FNP-C)
Entity type:Individual
Prefix:
First Name:PHU
Middle Name:BA
Last Name:LE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 208357
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8357
Mailing Address - Country:US
Mailing Address - Phone:512-485-7208
Mailing Address - Fax:737-304-0942
Practice Address - Street 1:7201 WYOMING SPG DR STE 400
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4311
Practice Address - Country:US
Practice Address - Phone:855-876-7246
Practice Address - Fax:855-277-5070
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1176303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner