Provider Demographics
NPI:1013394154
Name:KHOSA, RUGARE MUGABE (APRN FNP)
Entity Type:Individual
Prefix:MRS
First Name:RUGARE
Middle Name:MUGABE
Last Name:KHOSA
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:MS
Other - First Name:RUGARE
Other - Middle Name:VIMBAI
Other - Last Name:MUGABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12377 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3126
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:
Practice Address - Street 1:708 W SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7216
Practice Address - Country:US
Practice Address - Phone:214-570-9400
Practice Address - Fax:972-792-7268
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1128147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily