Provider Demographics
NPI:1356901581
Name:OBASANYA, ADEBUKOLA
Entity type:Individual
Prefix:
First Name:ADEBUKOLA
Middle Name:
Last Name:OBASANYA
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 1:688 W PIONEER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4861
Mailing Address - Country:US
Mailing Address - Phone:972-642-7337
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:469-202-7572
Practice Address - Fax:469-329-1044
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily