Provider Demographics
NPI:1073268991
Name:IKE, IJEOMA JOSEPHINE
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:JOSEPHINE
Last Name:IKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12130 BEAMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-4628
Mailing Address - Country:US
Mailing Address - Phone:512-774-1522
Mailing Address - Fax:
Practice Address - Street 1:HCA HEALTHCARE, CLEARLAKE
Practice Address - Street 2:495 W. MEDICAL CENTER BLVD
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-526-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018687363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics