MEDICARE: SARAH ILESANMI PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2022026241	TX

General Provider Information

NPI Number	:	1083341705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ILESANMI PMHNP

Provider Business Mailing Address
First Line	:	16903 RED OAK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3914
Country	:	US
Telephone Number	:	832-514-7925
Fax Number	:	281-572-8697

Provider Business Practice Location Address
First Line	:	16903 RED OAK DR STE 130F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3965
Country	:	US
Telephone Number	:	410-530-6628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	02/04/2026

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