Healthcare Provider Details

I. General information

NPI: 1013554617
Provider Name (Legal Business Name): IFEOMA NWAKAEGO IROKWE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 270
LARGO MD
20774-3709
US

IV. Provider business mailing address

2905 DUSTYWOOD DR
MCKINNEY TX
75071-6783
US

V. Phone/Fax

Practice location:
  • Phone: 877-306-2758
  • Fax: 877-306-2754
Mailing address:
  • Phone: 972-900-3652
  • Fax: 877-306-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP144105
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: