Provider Demographics
NPI:1568785921
Name:OKELOLA, FADEKE TOYIN (PA-C)
Entity Type:Individual
Prefix:
First Name:FADEKE
Middle Name:TOYIN
Last Name:OKELOLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FADEKE
Other - Middle Name:TOYIN
Other - Last Name:ADEWOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555
Mailing Address - Country:US
Mailing Address - Phone:409-772-3595
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77555
Practice Address - Country:US
Practice Address - Phone:409-772-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06672363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical