Provider Demographics
NPI:1447794094
Name:OLOJEDE, OLUYOMI OLUKEMI (RN, MSN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:OLUYOMI
Middle Name:OLUKEMI
Last Name:OLOJEDE
Suffix:
Gender:F
Credentials:RN, MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 STOVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2681
Mailing Address - Country:US
Mailing Address - Phone:214-404-6674
Mailing Address - Fax:
Practice Address - Street 1:3701 STOVER CREEK DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-2681
Practice Address - Country:US
Practice Address - Phone:214-404-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132572363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health