Krystal Family Psychiatry PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

KRYSTAL FAMILY PSYCHIATRY PLLC

Practice address

1675 Republic Pkwy Ste 104
Mesquite, TX 75150-6902

Phone

(469) 231-7232

NPI assigned

Oct 24, 2022

Organization subpart

No

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

Authorized official

Name

Keyna Nkemjika OmenukorNPI 1215307715

Title

Ceo

Phone

(469) 231-7232

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, DC, WA, NM4 enrollments

Enrollment records 4

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keyna Omenukor

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesquite, TX
  • NPI 1215307715

  DC, NM, WA

  Medicare reassignment NPD Authorized official
• Anike Grace Aganaba Alabi, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesquite, TX
  • NPI 1508743204
  Medicare reassignment NPD
• Jasmine Good

  • Professional Counselor
  • Dallas, TX
  • NPI 1619763273
  Medicare reassignment NPD
• Uchechi Catherine Uka, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesquite, TX
  • NPI 1558987784

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1699492298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 REPUBLIC PKWY STE 190",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751506902",
            "telephone_number": "469-231-7232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 REPUBLIC PKWY STE 104",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751506902",
            "telephone_number": "469-231-7232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "522 W Riverside Ave # 5343",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992010580",
            "country_code": "US",
            "telephone_number": "972-576-7399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KRYSTAL FAMILY PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-24",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "OMENUKOR",
        "authorized_official_first_name": "KEYNA",
        "authorized_official_middle_name": "NKEMJIKA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "469-231-7232"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kroger
• Kroger Texas L P
• Kroger Texas L P
• Kroger Texas L P
• Krystal Family Clinic LLC
• Kubosumi Chiropractic & Wellness, LLC
• Andrew Kubosumi, D.C.
• James Kun
• Anita Kurien, M.S., CCC-SLP
• Jaison Kuruvilla, RN

• Psychiatric/Mental Health Nurse Practitioner in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.