Provider Demographics
NPI:1356019897
Name:AKINNODI, OMOLOLA OMOYEMI (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:OMOLOLA
Middle Name:OMOYEMI
Last Name:AKINNODI
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 MATADOR DR
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75189-8846
Mailing Address - Country:US
Mailing Address - Phone:615-635-7287
Mailing Address - Fax:
Practice Address - Street 1:1140 NE HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-3240
Practice Address - Country:US
Practice Address - Phone:541-921-3584
Practice Address - Fax:541-614-1291
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30071363LF0000X
TX1052830363LP0808X
CO0101010363LP0808X
OR10019767363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily