Prajnawati Wibowo, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP139122 Issued in TX

Practice address

5301 Alpha Rd Ste 80-3
Dallas, TX 75240-4355

Phone

(682) 215-1691

Fax

(682) 267-4840

NPI assigned

Oct 29, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX, AZ, NY, CA, NM, WA, FL7 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 7

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lucent Home Health LLC Home health agency, Plano, TX, CCN 743191

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Grace in Healings PLLC

  • Psychiatric/Mental Health Registered Nurse
  • Dallas, TX
  • NPI 1699557694
  Medicare reassignment NPD Authorized official
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  AZ, NM, NY, Psychiatric/Mental Health, TX, WA

  Medicare reassignment NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  TX

  Medicare reassignment NPD
• Nisha Satish MD PA

  • Family Medicine Physician
  • Greenville, TX
  • NPI 1902171226
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lucent Home Health LLC

  • Home Health Agency
  • Plano, TX
  • NPI 1649462334
  Care Compare affiliation

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

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1760959696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 ALPHA RD STE 80-3",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752404355",
            "telephone_number": "682-215-1691",
            "fax_number": "682-267-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 ALPHA RD STE 80-3",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752404355",
            "telephone_number": "682-215-1691",
            "fax_number": "682-267-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIBOWO",
        "first_name": "PRAJNAWATI",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-29",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP139122",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP139122",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95034910",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AP139122",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "95034910",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DATA 2000 WAIVER",
            "identifier": "XW5044653",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wholistic Herbs Inc.
• Why Stop Learning, LLC
• Nicole A Whyte, P.T.
• Ocean Yanique Whyte, MSN, APRN, FNP-BC
• Frank Henry Wians Jr., PH.D.
• Sara B. Wick, GNP
• Gena Menzdorf Wickes, D.C.
• Jonathan Eric Wickiser, MD
• Lisa Baker Wicklund, LMFT-A
• Itala Manosha Wickremasinghe, MD

• Psychiatric/Mental Health Nurse Practitioner in Dallas, TX
• Providers in Dallas, 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 Oct 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.