Provider Demographics
NPI:1043710726
Name:HIRUY, TIRUWORK MEKURIA (RN-BSN, PMHNP- BC)
Entity Type:Individual
Prefix:
First Name:TIRUWORK
Middle Name:MEKURIA
Last Name:HIRUY
Suffix:
Gender:F
Credentials:RN-BSN, PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-8554
Mailing Address - Country:US
Mailing Address - Phone:214-478-2948
Mailing Address - Fax:
Practice Address - Street 1:9909 GLENSHEE DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-8332
Practice Address - Country:US
Practice Address - Phone:214-478-2948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067309363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043710726Medicaid