Provider Demographics
NPI:1972847515
Name:OLOYE ADELUSI, OMOLARA (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:OMOLARA
Middle Name:
Last Name:OLOYE ADELUSI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S MCDONALD ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-5625
Mailing Address - Country:US
Mailing Address - Phone:469-461-7286
Mailing Address - Fax:
Practice Address - Street 1:307 S MCDONALD ST STE 500
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-5625
Practice Address - Country:US
Practice Address - Phone:469-461-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0003457-C-NP363LP0808X, 363LP0808X
NY403623363LP0808X
AZ263319363LP0808X
TX1021681363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000200385Medicaid