Healthcare Provider Details

I. General information

NPI: 1326876178
Provider Name (Legal Business Name): BETTY CHELAGAT KIGEN AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 WARREN PKWY STE 115
FRISCO TX
75034-4063
US

IV. Provider business mailing address

760 AGAVE DR
PROSPER TX
75078-2254
US

V. Phone/Fax

Practice location:
  • Phone: 405-400-7458
  • Fax:
Mailing address:
  • Phone: 469-215-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1168522
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: