Organization
BROADWAY PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VELILE SIBUSISIWE NKOLOMI NP (CEO)
(469) 733-2090
Entity
Organization
Contact information
Practice address
3960 BROADWAY BLVD STE 232, GARLAND, TX 75043-2591
(469) 733-2090
Mailing address
2657 JOHNSON CT, FORNEY, TX 75126-1696
(469) 733-2090
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/24/2020
Last updated
07/11/2020
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