Provider Demographics
NPI:1972054450
Name:ICHIE, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:ICHIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:ORIAKU
Other - Last Name:OGBONNAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0051
Mailing Address - Country:US
Mailing Address - Phone:972-656-8258
Mailing Address - Fax:
Practice Address - Street 1:3740 N JOSEY LN STE 213
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2472
Practice Address - Country:US
Practice Address - Phone:972-656-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132314363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health