Provider Demographics
NPI:1558007617
Name:DIKIBO, PATIENCE MINA (PMHNP)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:MINA
Last Name:DIKIBO
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 1:3001 HIGHGATE DR
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-1435
Mailing Address - Country:US
Mailing Address - Phone:214-621-6164
Mailing Address - Fax:
Practice Address - Street 1:3230 WISCONSIN AVE STE A
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4073
Practice Address - Country:US
Practice Address - Phone:417-347-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220148372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry