Healthcare Provider Details

I. General information

NPI: 1497329445
Provider Name (Legal Business Name): TERESIAH S MUSYOKA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SE INNER LOOP
GEORGETOWN TX
78626-7700
US

IV. Provider business mailing address

1469 NEWBURY ST
GEORGETOWN TX
78626-7648
US

V. Phone/Fax

Practice location:
  • Phone: 512-819-9400
  • Fax:
Mailing address:
  • Phone: 512-800-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1036133
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: