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General NPI Number Information
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NPI Number | 1710624143
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Entity Type | Individual
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Provider Name | JOHN GIKUNGU MUTHIGA
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Gender | Male
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 873 S STEMMONS FWY STE 100
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City | LEWISVILLE
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State | TX
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Zip | 75067-5351
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Country | US
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Telephone | 713-516-3849
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Fax |
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Provider Business Mailing Address
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Address Line | 2637 HAMLET GREEN DR
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City | RALEIGH
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State | NC
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Zip | 27614-8076
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Country | US
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Telephone | 919-637-0325
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 226171
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1115893
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License Number State | TX
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