Provider Demographics
NPI:1760518732
Name:ADELANA, KEHINDE OLAJUBE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:KEHINDE
Middle Name:OLAJUBE
Last Name:ADELANA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 POSTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018
Mailing Address - Country:US
Mailing Address - Phone:817-466-8316
Mailing Address - Fax:817-419-6501
Practice Address - Street 1:2133 POSTWOOD LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018
Practice Address - Country:US
Practice Address - Phone:817-466-8316
Practice Address - Fax:817-419-6501
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607992163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101771Medicaid