Healthcare Provider Details

I. General information

NPI: 1063320679
Provider Name (Legal Business Name): MGNM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 VIA TOSCANA LN
ROCKWALL TX
75032-7540
US

IV. Provider business mailing address

1461 VIA TOSCANA LN
ROCKWALL TX
75032-7540
US

V. Phone/Fax

Practice location:
  • Phone: 903-309-3238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE MUSSON
Title or Position: MEDICAL DIRECTOR
Credential: MD/PHD
Phone: 903-309-3238