Provider Demographics
NPI:1093427726
Name:ADEBAYO, ELIZABETH OLUWAKEMI
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OLUWAKEMI
Last Name:ADEBAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 ANNA CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2404
Mailing Address - Country:US
Mailing Address - Phone:336-300-0712
Mailing Address - Fax:
Practice Address - Street 1:4920 EVERGREEN WAY SOUTH #1111
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2404
Practice Address - Country:US
Practice Address - Phone:281-749-1517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1100334363LP0808X
WAAP61384094363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health