Provider Demographics
NPI:1871904557
Name:HOANG, LY THIAI (MSN, APRN, NP-C)
Entity type:Individual
Prefix:
First Name:LY
Middle Name:THIAI
Last Name:HOANG
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 COMMERCIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4616
Mailing Address - Country:US
Mailing Address - Phone:512-985-6359
Mailing Address - Fax:866-216-2960
Practice Address - Street 1:102 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4616
Practice Address - Country:US
Practice Address - Phone:512-985-6359
Practice Address - Fax:209-885-6359
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily