Provider Demographics
NPI:1992989693
Name:NGUYEN, KAREN L (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SWIFT BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3513
Mailing Address - Country:US
Mailing Address - Phone:509-606-5040
Mailing Address - Fax:509-946-7253
Practice Address - Street 1:821 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3513
Practice Address - Country:US
Practice Address - Phone:509-606-5040
Practice Address - Fax:509-946-7253
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005282363A00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011502Medicaid
WA0448659OtherLABOR AND INDUSTRIES
WAP01470386OtherRR MEDICARE
WAG8933975Medicare PIN