Provider Demographics
NPI:1871877209
Name:CHOUNLAMANY, PHUONG-THAO KRISTY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:PHUONG-THAO
Middle Name:KRISTY
Last Name:CHOUNLAMANY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:PHUONG-THAO
Other - Middle Name:KRISTY
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:2705 PRINCE GEORGE AVE
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2045
Practice Address - Country:US
Practice Address - Phone:972-780-0480
Practice Address - Fax:972-780-1453
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant