Individual provider Active NPI

Jerusha N Muniu Nkoyo, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Colleyville, TX
National Provider Identifier
1043830748
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP144681 Issued in TX
Practice address
5017 Heritage Ave
Colleyville, TX 76034-5994
Phone
(817) 545-9100
NPI assigned
Apr 22, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 53-79400-111 KS
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP144681 TX Primary

Addresses

Primary practice location

5017 Heritage Ave
Colleyville, TX 76034-5994

Mailing address

5017 Heritage Ave
Colleyville, TX 76034-5994
Phone (817) 545-9100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200512000871 KS Practitioner - Nurse Practitioner 2264863075 Reassigns benefits to 1 organization
I20211028000329 TX Practitioner - Nurse Practitioner 2264863075 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
53-79400-111KSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pawnee Mental Health Service, Inc. CurrentSince Apr 29, 2020 Accepting new patients
Pawnee Mental Health Service, Inc. CurrentSince Apr 29, 2020 Accepting new patients
Affect Therapeutics Inc Community Health CurrentSince Jul 7, 2024 Accepting new patients
Grow Healthcare Group PA Psychiatric/Mental Health CurrentSince Dec 15, 2022 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

814 Caroline Ave
Junction City, KS 66441
Phone (785) 762-5250

2001 Claflin Rd
Manhattan, KS 66502

700 Milam St
Ste 1300
Houston, TX 77002
Phone (281) 801-8391

3800 Paluxy Dr
Ste 404
Tyler, TX 75703

1640 Boro Pl
Fl 4
Tysons, VA 22102
Phone (571) 440-1887

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1043830748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5017 HERITAGE AVE",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760345994",
            "telephone_number": "817-545-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5017 HERITAGE AVE",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760345994",
            "telephone_number": "817-545-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNIU NKOYO",
        "first_name": "JERUSHA",
        "middle_name": "N",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-22",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KS",
            "license": "53-79400-111",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP144681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colleyville, TX

Sources for this page

Verify at the official NPI Registry.