Individual provider Active NPI

Mojisola Nwofor, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Frisco, TX
National Provider Identifier
1760157622
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1050103 Issued in TX
Practice address
4139 Kearsage Dr
Frisco, TX 75034-9652
Phone
(815) 641-8720
NPI assigned
Aug 12, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1050103 TX Primary

Addresses

Primary practice location

4139 Kearsage Dr
Frisco, TX 75034-9652

Mailing address

4139 Kearsage Dr
Frisco, TX 75034-9652
Phone (815) 641-8720

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
I20220120002411 TX Practitioner - Nurse Practitioner 6901298116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
US Televero Health PAGroup PAC ID 7911318241, 37 clinicians

Practice addresses (Care Compare)

6101 W Courtyard Dr
Suite 2 225
Austin, TX 78730-5044
Phone (512) 956-5003

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1050103TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Blissful Psychiatry and Wellness Psychiatric/Mental Health Current 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": "1628726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1760157622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4139 KEARSAGE DR",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750349652",
            "telephone_number": "815-641-8720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4139 KEARSAGE DR",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750349652",
            "telephone_number": "815-641-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWOFOR",
        "first_name": "MOJISOLA",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-12",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1050103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, TX

Sources for this page

Verify at the official NPI Registry.