Provider Demographics
NPI:1801627476
Name:FO NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:FO NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FADEKEMI
Authorized Official - Middle Name:SULIAT
Authorized Official - Last Name:OLUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-449-7614
Mailing Address - Street 1:3449 AVA DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2274
Mailing Address - Country:US
Mailing Address - Phone:972-449-7614
Mailing Address - Fax:972-947-5275
Practice Address - Street 1:246-09 139TH AVENUE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422
Practice Address - Country:US
Practice Address - Phone:972-449-7614
Practice Address - Fax:972-947-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty