MEDICARE: IFEOMA GERALDINE MENAKAYA APRN

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	68735	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP146080	TX

General Provider Information

NPI Number	:	1205446499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFEOMA GERALDINE MENAKAYA APRN

Provider Business Mailing Address
First Line	:	3200 PECAN XING
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-2935
Country	:	US
Telephone Number	:	214-859-0375
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 PECAN XING
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-2935
Country	:	US
Telephone Number	:	214-859-0375
Fax Number	:

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	01/09/2026

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