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General NPI Number Information
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NPI Number | 1689238461
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Entity Type | Organization
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Legal Business Name | ICAN MEDICS AND PSYCH SERVICES PLLC
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 9535 FOREST LN STE 109
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City | DALLAS
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State | TX
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Zip | 75243-5934
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Country | US
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Telephone | 469-709-8444
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Fax | 469-709-8445
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Provider Business Mailing Address
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Address Line | 9535 FOREST LN STE 109
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City | DALLAS
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State | TX
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Zip | 75243-5934
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Country | US
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Telephone | 469-709-8444
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Fax | 469-709-8445
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | NGOZIKA TRACEY NJOKU
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Credential | PHMNP-BC, FNP-C
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Telephone | 339-364-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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