Healthcare Provider Details

I. General information

NPI: 1801452404
Provider Name (Legal Business Name): PETER SEKIMANGA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N INTERSTATE 35
DENTON TX
76201-5119
US

IV. Provider business mailing address

3000 N INTERSTATE 35
DENTON TX
76201-5119
US

V. Phone/Fax

Practice location:
  • Phone: 940-898-7144
  • Fax:
Mailing address:
  • Phone: 940-898-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140951
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP140951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: