Provider Demographics
NPI:1417562349
Name:ADEBOWALE, ADEBAYO (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ADEBAYO
Middle Name:
Last Name:ADEBOWALE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20422 ALPINE MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2583
Mailing Address - Country:US
Mailing Address - Phone:832-630-2570
Mailing Address - Fax:
Practice Address - Street 1:201 KINGWOOD MEDICAL DR STE A450
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6027
Practice Address - Country:US
Practice Address - Phone:832-701-0283
Practice Address - Fax:281-608-7543
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health