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General NPI Number Information
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NPI Number | 1417497397
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Entity Type | Individual
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Provider Name | KEZIAH MWANGI CPNP - PC
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Gender | Female
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 1935 MEDICAL DISTRICT DR
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City | DALLAS
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State | TX
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Zip | 75235-7701
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Country | US
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Telephone | 214-456-0766
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Fax |
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Provider Business Mailing Address
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Address Line | 10329 FLAT CREEK TRL
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City | MCKINNEY
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State | TX
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Zip | 75072-8964
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Country | US
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Telephone | 469-879-3605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP132584
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License Number State | TX
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