MEDICARE: DR. QUEEN OBIAGELI IGBO NP

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	1217065	TX

General Provider Information

NPI Number	:	1861337719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUEEN OBIAGELI IGBO NP

Provider Business Mailing Address
First Line	:	116 CORDOVA
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-3089
Country	:	US
Telephone Number	:	404-933-8152
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 CORDOVA
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-3089
Country	:	US
Telephone Number	:	404-933-8152
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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