Provider Demographics
NPI:1134689078
Name:ADEOYE, ABIBAT ADENIKE
Entity Type:Individual
Prefix:
First Name:ABIBAT
Middle Name:ADENIKE
Last Name:ADEOYE
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 1:5204 HAVANA DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5676
Mailing Address - Country:US
Mailing Address - Phone:214-909-7763
Mailing Address - Fax:
Practice Address - Street 1:3417 N MIDLAND DR APT 1810
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-4617
Practice Address - Country:US
Practice Address - Phone:214-909-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX948876163W00000X
NM72660363LP0808X
TX1099241363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse