Individual
PRAJNAWATI WIBOWO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5301 ALPHA RD STE 80-3, DALLAS, TX 75240-4355
(682) 215-1691
(682) 267-4840
Mailing address
5301 ALPHA RD STE 80-3, DALLAS, TX 75240-4355
(682) 215-1691
(682) 267-4840
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
AP139122
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
95034910
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP139122
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95034910
LICENSE
CA
01
—
AP139122
LICENSE
TX
01
—
XW5044653
DATA 2000 WAIVER
TX
Enumeration date
10/29/2018
Last updated
10/27/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us