Provider Demographics
NPI:1346788353
Name:MWANGI, PETER KIMITI (AG-ACNP-BC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:KIMITI
Last Name:MWANGI
Suffix:
Gender:M
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 MARKET CENTER BLVD APT 4217
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3430
Mailing Address - Country:US
Mailing Address - Phone:205-747-9949
Mailing Address - Fax:
Practice Address - Street 1:2929 WYCLIFF AVE
Practice Address - Street 2:APT 2227
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2646
Practice Address - Country:US
Practice Address - Phone:205-747-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132915363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care