Provider Demographics
NPI:1740094598
Name:ADETIMIRIN, PETERLAND DHAITI (PMHNP)
Entity type:Individual
Prefix:
First Name:PETERLAND
Middle Name:DHAITI
Last Name:ADETIMIRIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:PETERLAND
Other - Middle Name:
Other - Last Name:DHAITI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8712 MCCUTCHINS DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3550
Mailing Address - Country:US
Mailing Address - Phone:718-813-5109
Mailing Address - Fax:
Practice Address - Street 1:333 E BETHANY DR STE J100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3827
Practice Address - Country:US
Practice Address - Phone:214-777-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183816363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health