Provider Demographics
NPI:1114698289
Name:MKUBWA, BEATRICE TOWETT (APRN)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:TOWETT
Last Name:MKUBWA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BEATRICE
Other - Middle Name:TOWETT
Other - Last Name:MKUBWA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:124 BERRY DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4000
Mailing Address - Country:US
Mailing Address - Phone:817-849-4548
Mailing Address - Fax:
Practice Address - Street 1:8915 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-1717
Practice Address - Country:US
Practice Address - Phone:214-351-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61208134363LP0808X
TX1036201363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty