Provider Demographics
NPI:1164314662
Name:NJIRU, CONVINCE JEDDY MUTWIRI
Entity type:Individual
Prefix:
First Name:CONVINCE
Middle Name:JEDDY MUTWIRI
Last Name:NJIRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 NORIAS DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5045
Mailing Address - Country:US
Mailing Address - Phone:469-888-1971
Mailing Address - Fax:
Practice Address - Street 1:1187 NORIAS DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-5045
Practice Address - Country:US
Practice Address - Phone:469-888-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10047388363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health