Basic Information
| Provider Information | |||||||||
| NPI: | 1144791567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATSIKIRE | ||||||||
| FirstName: | TARIRO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1604 WESLEY DR | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750135865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035608833 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9708 SKILLMAN ST | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752435150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142215433 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP139936 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.