Provider Demographics
NPI:1700369816
Name:KEHINDE, BOLATITO ADENUGA (RN)
Entity Type:Individual
Prefix:
First Name:BOLATITO
Middle Name:ADENUGA
Last Name:KEHINDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 RIO BRAVO DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1751
Mailing Address - Country:US
Mailing Address - Phone:214-274-2637
Mailing Address - Fax:
Practice Address - Street 1:5221 RIO BRAVO DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1751
Practice Address - Country:US
Practice Address - Phone:214-274-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX638437163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse