Provider Demographics
NPI:1720699143
Name:YUSUF, RUKAYAT OMOLARA
Entity Type:Individual
Prefix:
First Name:RUKAYAT
Middle Name:OMOLARA
Last Name:YUSUF
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 1:8506 HEATHER MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2476
Mailing Address - Country:US
Mailing Address - Phone:713-679-4734
Mailing Address - Fax:
Practice Address - Street 1:8506 HEATHER MAPLE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2476
Practice Address - Country:US
Practice Address - Phone:713-679-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily