Provider Demographics
NPI:1386949931
Name:AMALU, JUSTINA IFEOMA (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:IFEOMA
Last Name:AMALU
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 RIVER BEND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6945
Mailing Address - Country:US
Mailing Address - Phone:214-743-1200
Mailing Address - Fax:214-630-3469
Practice Address - Street 1:1350 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1654
Practice Address - Country:US
Practice Address - Phone:214-330-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119944363LP0808X
TX668512363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307289402Medicaid
TX307289403Medicaid
TX8512NHOtherBCBS
TX307289402Medicaid