Provider Demographics
NPI:1235658550
Name:AKINYELE, EMMANUEL OMOTAYO (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:OMOTAYO
Last Name:AKINYELE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HAMILTON CHURCH RD UNIT 112
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1497
Mailing Address - Country:US
Mailing Address - Phone:615-519-8092
Mailing Address - Fax:
Practice Address - Street 1:3001 HAMILTON CHURCH RD UNIT 112
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1497
Practice Address - Country:US
Practice Address - Phone:615-519-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily