Provider Demographics
NPI:1942545736
Name:ADEKUNLE, FOLAKE (MD)
Entity Type:Individual
Prefix:
First Name:FOLAKE
Middle Name:
Last Name:ADEKUNLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 U OF A WAY
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1419
Mailing Address - Country:US
Mailing Address - Phone:870-779-6000
Mailing Address - Fax:870-779-6050
Practice Address - Street 1:3417 U OF A WAY
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1419
Practice Address - Country:US
Practice Address - Phone:870-779-6000
Practice Address - Fax:870-779-6050
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140240363LW0102X
NY421111363LW0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03577593Medicaid