Provider Demographics
NPI:1336863919
Name:AYO AJAYI, JOKOTOLA O (CRNP-PMH)
Entity Type:Individual
Prefix:MS
First Name:JOKOTOLA
Middle Name:O
Last Name:AYO AJAYI
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SIX POINT CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2073
Mailing Address - Country:US
Mailing Address - Phone:443-529-7148
Mailing Address - Fax:
Practice Address - Street 1:5438 YORK RD STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3837
Practice Address - Country:US
Practice Address - Phone:410-323-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203426363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health