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General NPI Number Information
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NPI Number | 1629540497
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Entity Type | Individual
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Provider Name | SIMEON NGISHU NP
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Gender | Male
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 9250 AMBERTON PKWY
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City | DALLAS
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State | TX
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Zip | 75243-3224
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Country | US
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Telephone | 682-236-3656
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 MISTLETOE BLVD STE 100
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City | FORT WORTH
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State | TX
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Zip | 76104-4048
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Country | US
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Telephone | 817-338-1300
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Fax | 817-335-9871
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP139942
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP139942
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License Number State | TX
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