Individual
KELLY L NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
13819 HANSON BLVD NW, ANDOVER, MN 55304-7608
(763) 392-4001
(763) 862-2091
Mailing address
13819 HANSON BLVD NW, ANDOVER, MN 55304-7608
(763) 392-4001
(763) 862-2091
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
3009765
KY
363LF0000X
Family Nurse Practitioner
Primary
6445
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201332080
—
IN
05
—
7100366930
—
KY
Enumeration date
10/13/2015
Last updated
04/04/2019
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