Basic Information
| Provider Information | |||||||||
| NPI: | 1558752329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VONG | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27700 NORTHWEST FWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774336767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3462316850 | ||||||||
| FaxNumber: | 3462316851 | ||||||||
| Practice Location | |||||||||
| Address1: | 27700 NORTHWEST FWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774336767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3462316850 | ||||||||
| FaxNumber: | 3462316851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95001424 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 1048153 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 95001424 | 01 | CA | BOARD OF REGISTERED NURSING | OTHER |