Provider Demographics
NPI:1790358976
Name:BAMIDELE, OLUWABUNMI M (RN, APRN, FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:OLUWABUNMI
Middle Name:M
Last Name:BAMIDELE
Suffix:
Gender:
Credentials:RN, APRN, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SHENSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3598
Mailing Address - Country:US
Mailing Address - Phone:323-337-3122
Mailing Address - Fax:
Practice Address - Street 1:275 CUMBERLAND BND
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1805
Practice Address - Country:US
Practice Address - Phone:615-782-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000195960163WA2000X
TNF07202380363LF0000X
TN2024028636363LP0808X
TNAPN0000028533363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN110732571OtherDRIVER'S LICENSE