MEDICARE: GEORGIANA IKENEME

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	1216606	TX

General Provider Information

NPI Number	:	1821585944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIANA IKENEME

Provider Business Mailing Address
First Line	:	1926 SANTA ANNA DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5611
Country	:	US
Telephone Number	:	817-448-4519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1926 SANTA ANNA DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5611
Country	:	US
Telephone Number	:	817-448-4519
Fax Number	:

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

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	01/09/2026

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Directions to “ GEORGIANA IKENEME ” Practice Location

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