Provider Demographics
NPI:1104607134
Name:KOINANGE, ALICE W (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:W
Last Name:KOINANGE
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N FLOYD RD STE 9
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4243
Mailing Address - Country:US
Mailing Address - Phone:469-369-2673
Mailing Address - Fax:
Practice Address - Street 1:1112 N FLOYD RD STE 9
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4243
Practice Address - Country:US
Practice Address - Phone:469-369-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138387363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health