Mukosolu Egwim
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Katy, TX
NPI 1124962253 · NPPES record last updated Apr 17, 2026
Key facts
- NPI
- 1124962253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 70107389 (TX)
- Practice address
- 4415 Upland Stream LN
Katy, TX 77493-3871 - Phone
- (512) 720-9855
- NPI assigned
- Apr 17, 2026
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Balanced Wellbeing Nationwide PA
Practice addresses (Care Compare)
Austin, TX 78705
Phone (877) 779-2429
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260609001924 | WA | Practitioner - Nurse Practitioner | 1456822667 | Reassigns benefits to 1 organization |
| I20260611000716 | TX | Practitioner - Nurse Practitioner | 1456822667 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70107389 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 70107389 | TX | Yes |
Addresses
Primary practice location
4415 Upland Stream LN
Katy, TX 77493-3871
Mailing address
4415 Upland Stream LN
Katy, TX 77493-3871
Other providers in Katy, TX
- Jami Edwards
- Laura D. Edwards
- Edwardstransport
- Rhemruru Egbegbetoro
- Nkemdilm Anastacia Egbo
- Justice Nonso Egwuatu
- Vanessa Egwuatu
- Mohammed Ehimeakhe
- Esther C Ehirim
- Jeanette Ehlers
All providers in Katy, TX · Psychiatric/Mental Health Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.