Provider Demographics
NPI:1922259910
Name:IBHADE, JOY (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:JOY
Middle Name:
Last Name:IBHADE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:O
Other - Last Name:IYASERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 SCOTT AND WHITE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6441
Practice Address - Country:US
Practice Address - Phone:979-207-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT078432367500000X
TXAP118537367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20660601Medicaid
TX8529UUOtherBLUE CROSS BLUE SHIELD
TXP00827795OtherRAILROAD MEDICARE
TX20660601Medicaid