Provider Demographics
NPI:1518365030
Name:OGUNGBAYI, CAROLINE JOKOTOLA
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:JOKOTOLA
Last Name:OGUNGBAYI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:JOKOTOLA
Other - Last Name:OGUNGBAYI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:12118 MEREWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2416
Mailing Address - Country:US
Mailing Address - Phone:832-647-6565
Mailing Address - Fax:
Practice Address - Street 1:12118 MEREWOOD LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2416
Practice Address - Country:US
Practice Address - Phone:832-647-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily