Provider Demographics
NPI:1689238461
Name:ICAN MEDICS AND PSYCH SERVICES PLLC
Entity Type:Organization
Organization Name:ICAN MEDICS AND PSYCH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NGOZIKA
Authorized Official - Middle Name:TRACEY
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:PHMNP-BC, FNP-C
Authorized Official - Phone:339-364-0717
Mailing Address - Street 1:9535 FOREST LN STE 109
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5934
Mailing Address - Country:US
Mailing Address - Phone:469-709-8444
Mailing Address - Fax:469-709-8445
Practice Address - Street 1:9535 FOREST LN STE 109
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5934
Practice Address - Country:US
Practice Address - Phone:469-709-8444
Practice Address - Fax:469-709-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty