Provider Demographics
NPI:1659073617
Name:OGUNYOMBO, BABAJIDE (NP)
Entity Type:Individual
Prefix:MR
First Name:BABAJIDE
Middle Name:
Last Name:OGUNYOMBO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 FLOWERING VINE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1666
Mailing Address - Country:US
Mailing Address - Phone:865-306-7492
Mailing Address - Fax:
Practice Address - Street 1:3653 FLOWERING VINE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1666
Practice Address - Country:US
Practice Address - Phone:865-306-7492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000030236363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner