Provider Demographics
NPI:1710624143
Name:MUTHIGA, JOHN GIKUNGU
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GIKUNGU
Last Name:MUTHIGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 HAMLET GREEN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8076
Mailing Address - Country:US
Mailing Address - Phone:919-637-0325
Mailing Address - Fax:
Practice Address - Street 1:873 S STEMMONS FWY STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-5351
Practice Address - Country:US
Practice Address - Phone:713-516-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC226171163WP0809X
TX1115893363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult