Provider Demographics
NPI:1982831954
Name:OMOLOLA, NKEM (APRN)
Entity Type:Individual
Prefix:
First Name:NKEM
Middle Name:
Last Name:OMOLOLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 KENDALL LAKE CT
Mailing Address - Street 2:
Mailing Address - City:KENDALL
Mailing Address - State:TX
Mailing Address - Zip Code:77407-9068
Mailing Address - Country:US
Mailing Address - Phone:281-935-2424
Mailing Address - Fax:866-936-6638
Practice Address - Street 1:7011 KENDALL LAKE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3781
Practice Address - Country:US
Practice Address - Phone:281-935-2424
Practice Address - Fax:866-936-6638
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132026363L00000X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner