MEDICARE: JOSEPHINE KECHI IROEGBU FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP126534	TX

General Provider Information

NPI Number	:	1245629120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE KECHI IROEGBU FNP

Provider Business Mailing Address
First Line	:	5700 AVENUE H
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-8100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 AVENUE H
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-8100
Country	:	US
Telephone Number	:	832-607-4474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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