Provider Demographics
NPI:1083221006
Name:IKECHI, IKECHI ALEX SR (PMHNP)
Entity type:Individual
Prefix:
First Name:IKECHI
Middle Name:ALEX
Last Name:IKECHI
Suffix:SR
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 CENTER HILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-2094
Mailing Address - Country:US
Mailing Address - Phone:214-971-3192
Mailing Address - Fax:
Practice Address - Street 1:6947 COAL CREEK PKWY SE # 281
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3136
Practice Address - Country:US
Practice Address - Phone:214-971-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ249505363LP0808X
WAAP61119959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty