Provider Demographics
NPI:1053341842
Name:NAKYONYI-NTWATWA, MOLLY MAGDALENE (MD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:MAGDALENE
Last Name:NAKYONYI-NTWATWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:MAGDALENE
Other - Last Name:ALAKAYI NAKYONYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:2510 W GRAND PKWY N
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2853
Practice Address - Country:US
Practice Address - Phone:713-442-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172007001Medicaid
TX172007004Medicaid
TX172007002Medicaid
TX172007004Medicaid
TX448938YKTVMedicare PIN
TX448938YKTUMedicare PIN
TX8D3824Medicare PIN
TX172007004Medicaid
TX448938YKTUMedicare PIN