Provider Demographics
NPI:1386292001
Name:ONWUBUYA, KIMBERLY NNEKA (PMHNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NNEKA
Last Name:ONWUBUYA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 REGENCY PKWY STE 113
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7818
Mailing Address - Country:US
Mailing Address - Phone:972-904-5760
Mailing Address - Fax:817-592-3323
Practice Address - Street 1:99 REGENCY PKWY STE 113
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7818
Practice Address - Country:US
Practice Address - Phone:972-904-5760
Practice Address - Fax:817-592-3323
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142883343900000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX417764401Medicaid
TX4177644Medicaid
TX45D2274936OtherCLIA