Provider Demographics
NPI:1932583291
Name:NGUYEN, OANH (PA)
Entity type:Individual
Prefix:
First Name:OANH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2104 GAUSE BLVD W
Mailing Address - Street 2:SUITE A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4130
Mailing Address - Country:US
Mailing Address - Phone:985-643-4575
Mailing Address - Fax:504-643-4513
Practice Address - Street 1:3715 WILLIAMS BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3075
Practice Address - Country:US
Practice Address - Phone:504-464-4550
Practice Address - Fax:504-465-8590
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200859363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2400118Medicaid
MS06631011Medicaid
LA412742YH3UMedicare PIN