Provider Demographics
NPI:1831821719
Name:VANG, KIA (FNP-C)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:VANG
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 1:7410 FRASER CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80530-7147
Mailing Address - Country:US
Mailing Address - Phone:303-717-6934
Mailing Address - Fax:
Practice Address - Street 1:7410 FRASER CIR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80530-7147
Practice Address - Country:US
Practice Address - Phone:303-717-6934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner