Provider Demographics
NPI:1578292140
Name:OMONIYI, FRANCIS TUNDE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:TUNDE
Last Name:OMONIYI
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:PO BOX 261092
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-1092
Mailing Address - Country:US
Mailing Address - Phone:972-232-7474
Mailing Address - Fax:972-232-7401
Practice Address - Street 1:6500 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4100
Practice Address - Country:US
Practice Address - Phone:972-232-7474
Practice Address - Fax:972-232-7401
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074762363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1074762OtherLICENSE