KATRINA L WILLIE-MUSOMA (NPI# 1003023979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003023979 |
| Entity Type | Individual |
| Full Name | KATRINA L WILLIE-MUSOMA |
| Credential | MD |
| Practice Address |
2800 E Broad St Ste 100 Mansfield TX 76063-6410 |
| Practice Telephone | (817) 557-5437 |
| Practice Fax Number | 8175390476 |
| Mailing Telephone | (817) 557-5437 |
| Mailing Fax Number | 8175390476 |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | M9742 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 195476005 | 05 | |
| MEDICARE GROUP NPI | 00R86C | 01 | |
| TX | TMHP/MEDICAID GROUP TPI | 084933301 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 998 Winscott Rd, Benbrook, TX 761262744 | 8172494155 | 8172490497 |
| Street Address |
2800 E BROAD ST STE 100 |
| City | MANSFIELD |
| State | TX |
| Zip Code | 76063-6410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568518173 | Natalie Kathleen Moore | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-01-26 |
| 1770994766 | Angalene Deapen Jackson | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063 | 2014-05-13 |
| 1275736480 | Heather Jarrell Havener | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-06-06 |
| 1952504276 | Robert Stephen Krombach | Obstetrics & Gynecology | 2800 E Broad St Ste 100, Mansfield, TX 76063-6410 | 2007-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558349 | Lindsey Vandyke, D.o. Pllc | Internal Medicine | 3150 E Broad Street, Ste 100, Mansfield, TX 76063 | 2020-08-13 |
| 1942819867 | Jennifer Que Chau Nguyen | Pharmacist | 980 U.S. 287 Frontage Rd #287, Mansfield, TX 76063 | 2020-07-27 |
| 1194346890 | Ana Maria Gonzalez | Dentist | 1600 Us Highway 287, Suite 102, Mansfield, TX 76063 | 2020-05-04 |
| 1245869080 | Stateserv Medical of Texas, LLC | Durable Medical Equipment & Medical Supplies | 7941 Rodeo Trail, Mansfield, TX 76063 | 2020-04-03 |
| 1649802232 | Mary Puanani Kamai | Nurse Practitioner | 1301 E. Debbie Lane, Suite 102 #1405, Mansfield, TX 76063 | 2020-02-11 |
| 1770123028 | Gladys Vera Nfodzo | Nurse Practitioner | 901 W. Broad St, Mansfield, TX 76063 | 2020-01-14 |
| 1669011300 | Alexa Smith | Nurse Practitioner | 2800 E Broad St #304, Mansfield, TX 76063 | 2019-12-28 |
| 1477190437 | Mel Rockwall LLC | Optometrist | 1701 East Broad Street, Ste 109, Mansfield, TX 76063 | 2019-12-09 |
| 1376185512 | Daniel Max & Marcandrea LLC | Optometrist | 1701 East Broad St., Ste 109, Mansfield, TX 76063 | 2019-10-09 |
| 1861046385 | Lacey Eaton | Counselor | 805 Killian Dr, Mansfield, TX 76063 | 2019-08-01 |
| Find all providers in zip 76063 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700123049 | Christy Kelly Ciccariello | Pediatrics | 4 Samoset Way, Mansfield, MA 02048 | 2013-01-07 |
| 1891055117 | Rebecca J Nduaguba | Pediatrics | 1029 S Trimble Rd, Mansfield, OH 44906-3427 | 2012-05-21 |
| 1396952263 | Erin Elizabeth Wallace | Pediatrics | 252 Matlock Rd Ste 330, Mansfield, TX 76063-4294 | 2007-05-17 |
| 1992917702 | Arlington Physicians, P.a. | Pediatrics | 706 Hunters Row Ct, Mansfield, TX 76063-4001 | 2007-05-04 |
| 1497892061 | Chandra R. Shaker | Pediatrics | 120 Sturges Ave Ste 1, Mansfield, OH 44903-2399 | 2007-01-31 |
| 1275689788 | Colleen J Mckinney | Pediatrics | 540 S Trimble Rd, Mansfield, OH 44906-3418 | 2007-01-26 |
| 1811096696 | Gretchen R Prater | Pediatrics | 2140 Fm 157 North, Mansfield, TX 76063-4847 | 2006-09-21 |
| 1235245895 | Linda K Phan | Pediatrics | 252 Matlock Rd Ste 300, Mansfield, TX 76063-4294 | 2006-08-23 |
| 1376550244 | Marcia T Sampson Md Pa | Pediatrics | 2140 Fm 157 N, Mansfield, TX 76031 | 2006-08-02 |
| 1407821655 | Kerstin Ann Archer | Pediatrics | 2140 Highway 157 N, Mansfield, TX 76063-4847 | 2006-02-21 |
| Find all providers in MANSFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.