Provider Demographics
NPI:1396491643
Name:KINYUA, CHARITY W (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:W
Last Name:KINYUA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:WANGUI
Other - Last Name:KINYUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:4116 ALCOTT LN
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2364
Mailing Address - Country:US
Mailing Address - Phone:405-361-3080
Mailing Address - Fax:
Practice Address - Street 1:5680 FRISCO SQUARE BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3319
Practice Address - Country:US
Practice Address - Phone:469-535-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2022000632363LP0808X
TX1074018363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health