Healthcare Provider Details

I. General information

NPI: 1871234351
Provider Name (Legal Business Name): NAOMI ANYONAH NYABUTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W MOCKINGBIRD LN
DALLAS TX
75247-4931
US

IV. Provider business mailing address

8124 WILDWOOD CT
NORTH RICHLAND HILLS TX
76182-3100
US

V. Phone/Fax

Practice location:
  • Phone: 469-983-1300
  • Fax: 888-234-7101
Mailing address:
  • Phone: 469-983-1300
  • Fax: 888-234-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1071079
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: