Provider Demographics
NPI:1922683127
Name:MUSOKE, AISHA KYABWE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:KYABWE
Last Name:MUSOKE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9117 SAGEWOOD DR APT 3204
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-2299
Mailing Address - Country:US
Mailing Address - Phone:682-564-5320
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4909
Practice Address - Country:US
Practice Address - Phone:817-702-6926
Practice Address - Fax:817-702-6930
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033834363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care