Katrina L Willie-Musoma
Pediatrician
2800 E Broad St Ste 100
Mansfield
, Texas 76063-6410
Katrina L Willie-Musoma
Pediatrician
2800 E Broad St Ste 100
Mansfield
, Texas 76063-6410
(817) 539-0476
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About
Features
Specialties
- Pediatrician
Languages spoken
- English
Location
First Address
- Katrina L Willie-Musoma
- 2800 E Broad St Ste 100
- Mansfield, TX
- Zip : 76063-6410
- Fax : (817) 539-0476
- Phone : (817) 557-5437
Second Address
- Katrina L Willie-Musoma
- 2800 E Broad St Ste 100
- Mansfield, TX
- Zip : 76063-6410
- Fax : (817) 539-0476
- Phone : (817) 557-5437
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | M9742 | TX |
National Provider Identifier
| NPI | 1003023979 |
|---|---|
| Provider Name | Katrina L Willie-Musoma |
| First Address | Mansfield, TX 76063-6410 |
| Second Address | Mansfield, TX 76063-6410 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/05/2007 |
| Last Update Date | 17/03/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00R86C | MEDICARE GROUP NPI (01) | |
| 084933301 | TMHP/MEDICAID GROUP TPI (01) | TX |
| 195476005 | (05) | TX |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.