Provider Demographics
NPI:1396317640
Name:TRAN, KIM THIEN (FNP-C)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:THIEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4695 MARTINS CROSSING WEST DR
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5743
Mailing Address - Country:US
Mailing Address - Phone:678-622-7412
Mailing Address - Fax:
Practice Address - Street 1:303 JESSE JEWELL PKWY SE UNIT 230
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3713
Practice Address - Country:US
Practice Address - Phone:470-290-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF04210591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily