Jacquelyn Dan-Phung Nguyen, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

4276 Issued in TN

Practice address

2103 Lantern LN
Oreland, PA 19075-2513

Phone

(901) 641-3000

Fax

(901) 373-0804

NPI assigned

Sep 16, 2020

Last updated

Mar 6, 2023By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Foner Med, PLLC

  dba Care Memphis Clinic

  • Primary Care Clinic/Center
  • Memphis, TN
  • NPI 1396192746
  Medicare reassignment
• MSK Group PC

  dba OrthoSouth

  • Orthopaedic Surgery Physician
  • Southaven, MS
  • NPI 1912303447
  NPD (past)
• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1265585806
  NPD (past)

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1912513987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 LANTERN LN",
            "city": "ORELAND",
            "state": "PA",
            "postal_code": "190752513",
            "telephone_number": "267-626-1377",
            "fax_number": "267-626-1377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 LANTERN LN",
            "city": "ORELAND",
            "state": "PA",
            "postal_code": "190752513",
            "telephone_number": "901-641-3000",
            "fax_number": "901-373-0804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "JACQUELYN",
        "middle_name": "DAN-PHUNG",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-16",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "4276",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "4276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1157550",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT",
            "identifier": "4276",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Charles Meyers Jr., LAT, ATC, L/COF
• Jessica Marie Minnick, MOT, OTR/L
• Kathryn J Moretto, MS CCC/SLP
• Leigh Noell Myers
• Patricia H. Ncube, PH.D
• Nostalgic Eyecare Inc
• Oreland Dental Care PLLC
• Oreland Family Chiropractic
• Aslene Elaine Palmer, M.D.
• Patricia Streit Perez, ATC

• Surgical Physician Assistant in Oreland, PA
• Providers in Oreland, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.