Provider Demographics
NPI:1780991083
Name:ADEOGUN, OLUKEMI OLUTOKUNBO (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:OLUKEMI
Middle Name:OLUTOKUNBO
Last Name:ADEOGUN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:OLUKEMI
Other - Middle Name:OLUTOKUNBO
Other - Last Name:ATOYOSOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:9708 SKILLMAN STREET
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:214-221-5433
Mailing Address - Fax:214-221-5433
Practice Address - Street 1:9708 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5150
Practice Address - Country:US
Practice Address - Phone:214-221-5433
Practice Address - Fax:214-932-1977
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX708538363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health