Provider Demographics
NPI:1902350770
Name:OLAGOKE, OMOBOLANLE OPEOLUWA (FNP-C, PMHNP-C)
Entity type:Individual
Prefix:
First Name:OMOBOLANLE
Middle Name:OPEOLUWA
Last Name:OLAGOKE
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 GREEN LEVEL WEST RD STE 209
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-7611
Mailing Address - Country:US
Mailing Address - Phone:617-515-3540
Mailing Address - Fax:919-799-5134
Practice Address - Street 1:3675 GREEN LEVEL WEST RD STE 209
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-7611
Practice Address - Country:US
Practice Address - Phone:919-267-4659
Practice Address - Fax:919-799-5134
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008848363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty