MEDICARE: MS. TOCHUKWU IFEOMA AJIBO PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1226870	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	LH61534566	WA

General Provider Information

NPI Number	:	1255121646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TOCHUKWU IFEOMA AJIBO PMHNP

Provider Business Mailing Address
First Line	:	610 UPTOWN BLVD STE 2000
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-3528
Country	:	US
Telephone Number	:	425-230-4858
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 UPTOWN BLVD STE 2000
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-3528
Country	:	US
Telephone Number	:	425-230-4858
Fax Number	:

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

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	06/08/2026

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