Olivia Chinonso Iheanacho

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1105564 Issued in TX

Practice address

4131 Spicewood Springs Rd
Austin, TX 78759-8661

Phone

(512) 732-2122

Fax

(512) 732-2124

NPI assigned

Jun 13, 2017

Last updated

Oct 26, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863
  Medicare reassignment NPD
• Uvalde County Hospital Authority

  dba Uvalde Memorial Hospital

  • Critical Access Hospital
  • Uvalde, TX
  • NPI 1740288505
  Medicare reassignment NPD
• Titus County Hospital District

  dba Titus Regional Medical Center

  • Multi-Specialty Clinic/Center
  • Mount Pleasant, TX
  • NPI 1063548881
  Medicare reassignment
• South Limestone Hospital District

  dba West Rest Haven

  • Skilled Nursing Facility
  • West, TX
  • NPI 1780633396
  NPD
• South Limestone Hospital District

  dba Limestone Medical Center

  • Critical Access Hospital
  • Groesbeck, TX
  • NPI 1861487779
  NPD
• Uvalde County Hospital Authority

  dba St. Juanita Retirement and Rehab

  • Skilled Nursing Facility
  • San Angelo, TX
  • NPI 1740165364
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1154851129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 COLLIER ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787042911",
            "telephone_number": "512-472-4357",
            "fax_number": "512-703-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 SPICEWOOD SPRINGS RD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787598661",
            "telephone_number": "512-732-2122",
            "fax_number": "512-732-2124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IHEANACHO",
        "first_name": "OLIVIA",
        "middle_name": "CHINONSO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-13",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1105564",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "835635",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ignite Adventures LLC (Head & Heart Integrative Psychotherapy)
• Ignite Medical Resort Round Rock LLC
• Ignite Medical Resort Round Rock, LLC
• Ignite Performance Physical Therapy LLC
• Mona Iguchi, MD, CSSD
• Steffan Ihegboro, DPT
• Annette Ihejiene
• Victoria Ihejieto
• Amanda Ihek
• Chinomso Ihenagwam

• Psychiatric/Mental Health Nurse Practitioner in Austin, TX
• Providers in Austin, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.