Provider Demographics
NPI:1831979814
Name:ADEFUYE, FUNKE KEHINDE (RN)
Entity type:Individual
Prefix:
First Name:FUNKE
Middle Name:KEHINDE
Last Name:ADEFUYE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9696 SKILLMAN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8334
Mailing Address - Country:US
Mailing Address - Phone:214-664-9300
Mailing Address - Fax:214-664-9301
Practice Address - Street 1:9696 SKILLMAN ST STE 225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8334
Practice Address - Country:US
Practice Address - Phone:214-664-9300
Practice Address - Fax:214-664-9301
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX618846163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health