Healthcare Provider Details

I. General information

NPI: 1255121646
Provider Name (Legal Business Name): TOCHUKWU IFEOMA AJIBO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 UPTOWN BLVD STE 2000
CEDAR HILL TX
75104-3528
US

IV. Provider business mailing address

610 UPTOWN BLVD STE 2000
CEDAR HILL TX
75104-3528
US

V. Phone/Fax

Practice location:
  • Phone: 425-230-4858
  • Fax:
Mailing address:
  • Phone: 425-230-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1226870
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberLH61534566
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: