Provider Demographics
NPI:1891522546
Name:KHAMBOUNLUANG, GENA
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:KHAMBOUNLUANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MEDICAL DR STE 240
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6372
Mailing Address - Country:US
Mailing Address - Phone:469-800-4500
Mailing Address - Fax:469-800-4510
Practice Address - Street 1:204 MEDICAL DR STE 240
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6372
Practice Address - Country:US
Practice Address - Phone:469-800-4500
Practice Address - Fax:469-800-4510
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1167238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily