Provider Demographics
NPI:1457010860
Name:OKE, ADEDUNTAN OLABISI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ADEDUNTAN
Middle Name:OLABISI
Last Name:OKE
Suffix:
Gender:F
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 1:5919 LAKESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1962
Mailing Address - Country:US
Mailing Address - Phone:267-304-0247
Mailing Address - Fax:
Practice Address - Street 1:4820 BUSINESS CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1907
Practice Address - Country:US
Practice Address - Phone:707-703-5075
Practice Address - Fax:707-703-5076
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025384363LP0808X
FL11016552363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health