Provider Demographics
NPI:1871234351
Name:NYABUTO, NAOMI ANYONAH
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:ANYONAH
Last Name:NYABUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8124 WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-3100
Mailing Address - Country:US
Mailing Address - Phone:469-983-1300
Mailing Address - Fax:888-234-7101
Practice Address - Street 1:1420 W MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4931
Practice Address - Country:US
Practice Address - Phone:469-983-1300
Practice Address - Fax:888-234-7101
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071079363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health