MEDICARE: ROBERTINE KENGNI

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1076993	TX

General Provider Information

NPI Number	:	1871265702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTINE KENGNI

Provider Business Mailing Address
First Line	:	3720 CHERRY HILLS DR
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-5170
Country	:	US
Telephone Number	:	443-360-7971
Fax Number	:

Provider Business Practice Location Address
First Line	:	5899 PRESTON RD STE 1202
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-9594
Country	:	US
Telephone Number	:	214-592-8159
Fax Number	:

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

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	03/03/2025

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