Stephanie Chan Nguyen

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA06983 Issued in TX

Practice address

621 SW Johnson Ave
Ste C
Burleson, TX 76028-5834

Phone

(817) 766-7421

Fax

(817) 447-8100

NPI assigned

Oct 12, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prestige Dermatology PLLCGroup PAC ID 2365752813, 5 clinicians

Prestige Dermatology of Alliance PLLCGroup PAC ID 4284930959, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Prestige Dermatology of Alliance, PLLC

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1427415314
  Medicare reassignment Care Compare group
• Prestige Dermatology PLLC

  • Dermatology Physician
  • Burleson, TX
  • NPI 1962878843
  Medicare reassignment Care Compare group
• Wellworx Dermatology PLLC

  • Dermatology Physician
  • Frisco, TX
  • NPI 1164244703
  NPD (past)

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

{
    "created_epoch": "1286841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468281600000",
    "number": "1316257314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 SW JOHNSON AVE",
            "address_2": "STE C",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760285834",
            "telephone_number": "817-766-7421",
            "fax_number": "817-447-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 SW JOHNSON AVE",
            "address_2": "STE C",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760285834",
            "telephone_number": "817-766-7421",
            "fax_number": "817-447-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "STEPHANIE",
        "middle_name": "CHAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-12",
        "last_updated": "2016-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA06983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joey Thien Nguyen, PHARM.D.
• Marie Antoinette Nguyen, MSN, APRN, FNP-C
• Peter Luan Nguyen
• Phuc Thanh Nguyen, DO
• Quinn Nguyen, PHARMD
• Tammy Nguyen, LCSW
• Bethany Nichols, PTA
• Matthew Nickell, MD
• Donna Shemanne Nickerson, LCSW
• Olga Nikitina, LPC

• Medical Physician Assistant in Burleson, TX
• Providers in Burleson, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.