1013394154 NPI number — MRS. RUGARE MUGABE KHOSA APRN FNP

Table of content: MRS. RUGARE MUGABE KHOSA APRN FNP (NPI 1013394154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013394154 NPI number — MRS. RUGARE MUGABE KHOSA APRN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHOSA
Provider First Name:
RUGARE
Provider Middle Name:
MUGABE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUGABE
Provider Other First Name:
RUGARE
Provider Other Middle Name:
VIMBAI
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013394154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12377 MERIT DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75251-3126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-957-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 W SPRING VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75080-7216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-570-9400
Provider Business Practice Location Address Fax Number:
972-792-7268
Provider Enumeration Date:
04/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1128147 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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