Healthcare Provider Details

I. General information

NPI: 1619447901
Provider Name (Legal Business Name): JANE MOKWENYE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W MAIN ST APT 808
LEWISVILLE TX
75067-3345
US

IV. Provider business mailing address

50 S B B KING BLVD # 100
MEMPHIS TN
38103-2626
US

V. Phone/Fax

Practice location:
  • Phone: 972-339-8293
  • Fax:
Mailing address:
  • Phone: 901-436-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP139867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: