Provider Demographics
NPI:1952125429
Name:PROSPER PSYCHIATRY PLLC
Entity type:Organization
Organization Name:PROSPER PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-566-6092
Mailing Address - Street 1:8744 ELBE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7490
Mailing Address - Country:US
Mailing Address - Phone:206-771-7147
Mailing Address - Fax:
Practice Address - Street 1:8744 ELBE TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-7490
Practice Address - Country:US
Practice Address - Phone:205-566-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty