Provider Demographics
NPI:1114495983
Name:NGUMEZI, NWAMAKA (PMHNP)
Entity Type:Individual
Prefix:
First Name:NWAMAKA
Middle Name:
Last Name:NGUMEZI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 GASTON AVE STE 815
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2034
Mailing Address - Country:US
Mailing Address - Phone:214-520-7575
Mailing Address - Fax:
Practice Address - Street 1:3417 GASTON AVE STE 815
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2034
Practice Address - Country:US
Practice Address - Phone:214-520-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139656363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty