MEDICARE: JOHN GIKUNGU MUTHIGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	226171	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1115893	TX

General Provider Information

NPI Number	:	1710624143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GIKUNGU MUTHIGA

Provider Business Mailing Address
First Line	:	2637 HAMLET GREEN DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-8076
Country	:	US
Telephone Number	:	919-637-0325
Fax Number	:

Provider Business Practice Location Address
First Line	:	873 S STEMMONS FWY STE 100
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-5351
Country	:	US
Telephone Number	:	713-516-3849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	11/29/2023

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Directions to “ JOHN GIKUNGU MUTHIGA ” Practice Location

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