KATRINA L WILLIE-MUSOMA MD NPI 1003023979

NPI Information

NPI: 1003023979
Provider Name: KATRINA L WILLIE-MUSOMA, MD
Classification: Pediatrics - 2080P0008X
Entity Type: Individual

Specialization: Neurodevelopmental Disabilities

PECOS Registration: Yes

Address:
2800 E BROAD ST STE 100
MANSFIELD, TX
ZIP 76063
Phone: (817) 557-5437
Get Directions

Katrina L Willie-musoma, MD is a neurodevelopmental disabilities pediatrics in Mansfield, TX. The provider is a pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina bifida, autism, and other chronic neurologic conditions. Katrina L Willie-musoma, MD NPI is 1003023979. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2800 E BROAD ST STE 100
MANSFIELD, TX
ZIP 76063-410
Phone: (817) 557-5437
Fax: (817) 539-0476

The NPI 1003023979 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/17/2007 and was last updated on 12/28/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		M9742	TEXAS	No
2	2080P0008X	Pediatrics	Neurodevelopmental Disabilities	M9742	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00R86C	OTHER		MEDICARE GROUP NPI
2	084933301	OTHER	TEXAS	TMHP/MEDICAID GROUP TPI
3	195476005	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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