Healthcare Provider Details

I. General information

NPI: 1033025689
Provider Name (Legal Business Name): DENNIS MUTISYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7014 PEARL TERRACE LN
ROSENBERG TX
77469-1891
US

IV. Provider business mailing address

7014 PEARL TERRACE LN
ROSENBERG TX
77469-1891
US

V. Phone/Fax

Practice location:
  • Phone: 919-522-5912
  • Fax:
Mailing address:
  • Phone: 919-522-5912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1131295
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: