Provider Demographics
NPI:1578251070
Name:MBILIKIRA, NGOMENI M (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:NGOMENI
Middle Name:M
Last Name:MBILIKIRA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 W FM 544 UNIT 625
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3330
Mailing Address - Country:US
Mailing Address - Phone:214-432-1669
Mailing Address - Fax:214-416-7823
Practice Address - Street 1:3960 BROADWAY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2593
Practice Address - Country:US
Practice Address - Phone:972-836-7985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116341363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health