MEDICARE: KND BEHAVIORAL HEALTH CLINIC PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700483468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KND BEHAVIORAL HEALTH CLINIC PLLC

Provider Business Mailing Address
First Line	:	99 REGENCY PKWY STE 113
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7818
Country	:	US
Telephone Number	:	972-904-5760
Fax Number	:	817-592-3323

Provider Business Practice Location Address
First Line	:	99 REGENCY PKWY STE 113
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7818
Country	:	US
Telephone Number	:	972-904-5760
Fax Number	:	817-592-3323

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY ONWUBUYA
Credential	:	PMHNP
Telephone Number	:	661-472-4897

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	03/05/2024

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