Provider Demographics
NPI:1790241149
Name:KADIRI, MUKAILA ABIOLA (NP)
Entity Type:Individual
Prefix:
First Name:MUKAILA
Middle Name:ABIOLA
Last Name:KADIRI
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 1:2034 S SIERRA HILLS CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7528
Mailing Address - Country:US
Mailing Address - Phone:316-990-1509
Mailing Address - Fax:
Practice Address - Street 1:9390 E CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2565
Practice Address - Country:US
Practice Address - Phone:316-733-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5378552041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily