Provider Demographics
NPI:1679084610
Name:OLAYIWOLE, FOLASADE OLUFUNMILOLA (PMHNP)
Entity Type:Individual
Prefix:DR
First Name:FOLASADE
Middle Name:OLUFUNMILOLA
Last Name:OLAYIWOLE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5931 CROSSLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6986
Mailing Address - Country:US
Mailing Address - Phone:254-870-4874
Mailing Address - Fax:
Practice Address - Street 1:1111 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7929
Practice Address - Country:US
Practice Address - Phone:325-698-6600
Practice Address - Fax:325-698-6600
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135506363LP0808X
WAAP61147991363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty