Individual provider Active NPI

Keziah Mwangi, CPNP - PC

  • Pediatric Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1417497397
Registry record updated Feb 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
AP132584 Issued in TX
Practice address
1935 Medical District Dr
Dallas, TX 75235-7701
Phone
(214) 456-0766
NPI assigned
Feb 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X AP132584 TX Primary

Addresses

Primary practice location

1935 Medical District Dr
Dallas, TX 75235-7701

Mailing address

10329 Flat Creek TRL
McKinney, TX 75072-8964
Phone (469) 879-3605

Other names 1

  • Keziah Karanja Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190716001010 TX Practitioner - Nurse Practitioner 0345575171 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP132584TXMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Complex Care Medical Services Corporation Past Accepting new patients

Organizations & group practices 2

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": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1417497397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10329 FLAT CREEK TRL",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750728964",
            "telephone_number": "469-879-3605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 MEDICAL DISTRICT DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357701",
            "telephone_number": "214-456-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MWANGI",
        "first_name": "KEZIAH",
        "credential": "CPNP - PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-27",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP132584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEZIAH",
            "last_name": "KARANJA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.