Provider Demographics
NPI:1639996242
Name:KLE NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:KLE NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:KEMISOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBIETOMIYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-378-3144
Mailing Address - Street 1:548 WESTWOOD WAY DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3079
Mailing Address - Country:US
Mailing Address - Phone:347-378-3144
Mailing Address - Fax:469-242-9827
Practice Address - Street 1:109 N 12TH ST STE 704
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1002
Practice Address - Country:US
Practice Address - Phone:347-378-3144
Practice Address - Fax:469-242-9827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty