Provider Demographics
NPI:1932507381
Name:AGBODO, OLAYINKA
Entity Type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:
Last Name:AGBODO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16215 CLAY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5493
Mailing Address - Country:US
Mailing Address - Phone:281-656-8476
Mailing Address - Fax:
Practice Address - Street 1:16215 CLAY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5493
Practice Address - Country:US
Practice Address - Phone:281-656-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128483363LF0000X
MDR176893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily