Loan Kim Phan, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

53-75552-102 Issued in KS

Practice address

1624 N Rock Rd
Derby, KS 67037-3718

Phone

(316) 554-2126

Fax

(316) 554-2128

NPI assigned

Feb 10, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  • NPI 1538135207
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1245503986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 N ROCK RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373718",
            "telephone_number": "316-554-2126",
            "fax_number": "316-554-2128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 N ROCK RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373718",
            "telephone_number": "316-554-2126",
            "fax_number": "316-554-2128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1861 N Rock Rd",
            "address_2": "Suite 310",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672064200",
            "country_code": "US",
            "telephone_number": "316-612-1833",
            "fax_number": "316-612-2420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "LOAN",
        "middle_name": "KIM",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-10",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-75552-102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Derby, KS
• Providers in Derby, KS by specialty
• Family Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.