Katrina L Willie-musoma, MD | |
2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | |
(817) 557-5437 | |
(817) 539-0476 |
Full Name | Katrina L Willie-musoma |
---|---|
Gender | Female |
Speciality | Pediatrics - Neurodevelopmental Disabilities |
Location | 2800 E Broad St Ste 100, Mansfield, Texas |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003023979 | NPI | - | NPPES |
00R86C | Other | MEDICARE GROUP NPI | |
084933301 | Other | TX | TMHP/MEDICAID GROUP TPI |
195476005 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | M9742 (Texas) | Secondary |
2080P0008X | Pediatrics - Neurodevelopmental Disabilities | M9742 (Texas) | Primary |
Entity Name | Cook Childrens Physician Network |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1750369203 PECOS PAC ID: 7719884584 Enrollment ID: O20040128000800 |
Mailing Address | Practice Location Address |
---|---|
Katrina L Willie-musoma, MD 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 Ph: (817) 557-5437 | Katrina L Willie-musoma, MD 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 Ph: (817) 557-5437 |
Clive G Daniels, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 Matlock Rd, Mansfield, TX 76063 Phone: 817-453-5437 Fax: 817-453-2714 | |
Dr. Naima Garrett, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1759 Broad Park Cir S Ste 201, Mansfield, TX 76063 Phone: 682-341-3910 Fax: 682-400-1288 | |
Matthew Raymond Lussier, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 Matlock Rd, Mansfield, TX 76063 Phone: 817-453-5437 | |
Linda K Phan, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 252 Matlock Rd Ste 300, Mansfield, TX 76063 Phone: 817-557-5473 Fax: 817-539-0476 | |
Melvin T Joki, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 Matlock Rd, Mansfield, TX 76063 Phone: 817-453-5437 Fax: 817-453-2714 | |
Robert W Mann, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 Matlock Rd, Mansfield, TX 76063 Phone: 817-453-5437 Fax: 817-453-2714 |