AUDREY MARIETTA PHAN MD
NPI 1922740356
Student in an Organized Health Care Education/Training Program in Dallas, TX

Q: What is Audrey Phan's NPI number?

The NPI number for Audrey Phan is 1922740356. It was assigned to this individual provider in the NPPES registry on April 7, 2022.

Q: What is Audrey Phan's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Audrey Phan was last updated on April 7, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 07, 2022PECOS Enrolled

1441 N BECKLEY AVE, DALLAS, TX 75203(214) 947-6700 Get Directions Write a Review

NPPES record last updated: April 7, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Audrey Marietta Phan Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AUDREY MARIETTA PHAN MD (NPI 1922740356) is an individual student in an organized health care education/training program in Dallas, Texas and active in the NPI registry since April 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1922740356

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameAUDREY MARIETTA PHANCredential: MD

Location Address1441 N BECKLEY AVEDallas, TX 75203-1201

Mailing Address5623 Hamilton Wolfe Apt 523San Antonio, TX 78240-4055 · (847) 840-8790

Phone(214) 947-6700

Sole ProprietorYes

Enumeration DateApril 7, 2022

NPPES CertifiedApril 7, 2022

✔ NPI 1922740356 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1441 N BECKLEY AVE, Dallas, TX 75203

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Audrey Marietta Phan Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WILLIAM COOK LANGMADE MD

Internal Medicine