Varoun Upha Princella Phomvongsa, RN

Key facts

NPI

1669360301

Entity type

Individual (NPI type 1)

Primary specialty

Registered Nurse 163W00000X

License

13-162509 (KS)

Practice address

3600 E Harry St
Wichita, KS 67218-3713

Phone

(316) 689-5252

NPI assigned

Jun 24, 2025

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Nurse

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 24, 2025.

{
    "created_epoch": "1750723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1669360301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 E HARRY ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672183713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 E HARRY ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672183713",
            "telephone_number": "316-689-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOMVONGSA",
        "first_name": "VAROUN UPHA",
        "middle_name": "PRINCELLA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-06-24",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KS",
            "license": "13-162509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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