Provider Demographics
NPI:1033797162
Name:IRABOR, JUDITH (MSN, APN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:IRABOR
Suffix:
Gender:F
Credentials:MSN, APN, PMHNP-BC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:IRABOR ANEGBODE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6623 NORTHRIDGE TRACE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7577
Mailing Address - Country:US
Mailing Address - Phone:347-995-6021
Mailing Address - Fax:
Practice Address - Street 1:8701 NEW TRAILS DR STE 150
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4546
Practice Address - Country:US
Practice Address - Phone:281-367-1015
Practice Address - Fax:281-367-1966
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX923792163WP0808X
TX2021036599363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health