Provider Demographics
NPI:1568295475
Name:PHAM, NGUYEN (FNP-C)
Entity type:Individual
Prefix:
First Name:NGUYEN
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NGUYEN
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4120 SOUTHWEST FWY STE 175
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7339
Mailing Address - Country:US
Mailing Address - Phone:713-291-5659
Mailing Address - Fax:
Practice Address - Street 1:4120 SOUTHWEST FWY STE 175
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7339
Practice Address - Country:US
Practice Address - Phone:713-291-5659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily