MEDICARE: NELSON JONG KWOWI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	888347	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1019811	TX

General Provider Information

NPI Number	:	1689203853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSON JONG KWOWI

Provider Business Mailing Address
First Line	:	5904 LANTERN LN
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-8768
Country	:	US
Telephone Number	:	325-320-0414
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 BLUE ROSE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-2678
Country	:	US
Telephone Number	:	469-490-1505
Fax Number	:	469-490-1516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	11/08/2023

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Directions to “ NELSON JONG KWOWI ” Practice Location

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