Provider Demographics
NPI:1750037677
Name:MUTUKA, PATIENCE (PMHNP)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:MUTUKA
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 1:3420 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1516
Mailing Address - Country:US
Mailing Address - Phone:469-605-0673
Mailing Address - Fax:
Practice Address - Street 1:6110 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7912
Practice Address - Country:US
Practice Address - Phone:682-236-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2021117984363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health