Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Prajnawati Wibowo, NP

Individual provider Acute Care Nurse Practitioner · NPI 1760959696

Prajnawati Wibowo, NP is a Nurse Practitioner in Dallas, Texas. Qualified in 2022, 4 years ago. Accepts Medicare assignment and offers telehealth. Licensed in California and Texas.

Years since qualifying
4
Licensed in
CA, TX
In the registry since
2018
Specialties on file
3
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

5301 Alpha Rd Ste 80-3
Dallas, TX 75240-4355
Phone: (682) 215-1691
Fax: (682) 267-4840
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence AP139122 (TX)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence AP139122 (TX)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 95034910 (CA)

Record details

NPI number1760959696
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedOctober 29, 2018
Last updated in NPPESOctober 27, 2025
Certification dateOctober 27, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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