Provider Demographics
NPI:1093285504
Name:DAWOTOLA, KIKELOMO OMOLOLA (FNP)
Entity Type:Individual
Prefix:
First Name:KIKELOMO
Middle Name:OMOLOLA
Last Name:DAWOTOLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KIKELOMO
Other - Middle Name:OMOLOLA
Other - Last Name:APANTAKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1008 ANGIE LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3870
Mailing Address - Country:US
Mailing Address - Phone:214-281-9480
Mailing Address - Fax:
Practice Address - Street 1:3330 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4531
Practice Address - Country:US
Practice Address - Phone:214-743-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP139838OtherTEXAS BOARD OF NURSING