Provider Demographics
NPI:1427161389
Name:VANG, BLIA HER (FNP/PMHNP)
Entity type:Individual
Prefix:MS
First Name:BLIA
Middle Name:HER
Last Name:VANG
Suffix:
Gender:F
Credentials:FNP/PMHNP
Other - Prefix:
Other - First Name:BLIA
Other - Middle Name:HER
Other - Last Name:KONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP/PMHNP
Mailing Address - Street 1:12314 LONGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-3024
Mailing Address - Country:US
Mailing Address - Phone:864-279-1839
Mailing Address - Fax:
Practice Address - Street 1:11920 ASTORIA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6097
Practice Address - Country:US
Practice Address - Phone:281-481-4646
Practice Address - Fax:281-481-4649
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX817327363LF0000X
TXAP120869363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health