MEDICARE: ADESUWA ADESEMOWO PMHNP-BC

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	1063575	TX

General Provider Information

NPI Number	:	1437085156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADESUWA ADESEMOWO PMHNP-BC

Provider Business Mailing Address
First Line	:	600 SANTA BARBARA DR
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-4105
Country	:	US
Telephone Number	:	210-773-1119
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SANTA BARBARA DR
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-4105
Country	:	US
Telephone Number	:	210-773-1119
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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