Provider Demographics
NPI:1770941924
Name:UNIVERSITY OF NORTH TEXAS
Entity type:Organization
Organization Name:UNIVERSITY OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:KEMUNTO
Authorized Official - Last Name:MOSE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:817-412-8521
Mailing Address - Street 1:PO BOX 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-702-3636
Mailing Address - Fax:817-702-8439
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-702-3636
Practice Address - Fax:807-702-8439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER AT FORTWORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-03
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129874283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital