Provider Demographics
NPI:1043830748
Name:MUNIU NKOYO, JERUSHA N (APRN)
Entity Type:Individual
Prefix:
First Name:JERUSHA
Middle Name:N
Last Name:MUNIU NKOYO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5994
Mailing Address - Country:US
Mailing Address - Phone:817-545-9100
Mailing Address - Fax:
Practice Address - Street 1:5017 HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5994
Practice Address - Country:US
Practice Address - Phone:817-545-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79400-111363LP0808X
TXAP144681363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health