Provider Demographics
NPI:1720645666
Name:ADEDIRAN, JUBRIL ALADE (PMHNP-BC, DNP)
Entity Type:Individual
Prefix:
First Name:JUBRIL
Middle Name:ALADE
Last Name:ADEDIRAN
Suffix:
Gender:M
Credentials:PMHNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 AIMUA CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-3741
Mailing Address - Country:US
Mailing Address - Phone:713-992-5685
Mailing Address - Fax:
Practice Address - Street 1:7615 AIMUA CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-3741
Practice Address - Country:US
Practice Address - Phone:713-992-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202214179RN163WP0808X
TXAP141677363LF0000X, 363LP0808X
OR202214466NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14474670OtherCAQH ID
OR500813853Medicaid