Provider Demographics
NPI:1255687497
Name:AKEREDOLU, OLUWASEUN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:OLUWASEUN
Middle Name:
Last Name:AKEREDOLU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:OLUWASEUN
Other - Middle Name:
Other - Last Name:EGBEJIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22219 BRIDGESTONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3534
Mailing Address - Country:US
Mailing Address - Phone:281-971-1145
Mailing Address - Fax:
Practice Address - Street 1:22219 BRIDGESTONE OAK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3534
Practice Address - Country:US
Practice Address - Phone:281-971-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant