Provider Demographics
NPI:1497329445
Name:MUSYOKA, TERESIAH S (PMHNP)
Entity Type:Individual
Prefix:
First Name:TERESIAH
Middle Name:S
Last Name:MUSYOKA
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 1:1469 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7648
Mailing Address - Country:US
Mailing Address - Phone:512-800-9299
Mailing Address - Fax:
Practice Address - Street 1:1469 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7648
Practice Address - Country:US
Practice Address - Phone:512-800-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036133363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health