Healthcare Provider Details

I. General information

NPI: 1275221558
Provider Name (Legal Business Name): DIANA NGUMSINA MUYONGA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14829 BELLAIRE BLVD STE 13B-5
HOUSTON TX
77083-2500
US

IV. Provider business mailing address

14829 BELLAIRE BLVD STE 13B-5
HOUSTON TX
77083-2500
US

V. Phone/Fax

Practice location:
  • Phone: 346-631-5576
  • Fax: 346-631-5576
Mailing address:
  • Phone: 346-631-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024192885
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1115134
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number406009
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5018618
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: