MEDICARE: ADEOLA AMINAT ADEBAYO 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	364SP0810X	Child & Family Psychiatric/Mental Health Clinical Nurse Specialist	AP142733	TX

General Provider Information

NPI Number	:	1861048597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEOLA AMINAT ADEBAYO PMHNP

Provider Business Mailing Address
First Line	:	2716 WATER OAK DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4448
Country	:	US
Telephone Number	:	469-740-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	2716 WATER OAK DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4448
Country	:	US
Telephone Number	:	469-740-2811
Fax Number	:

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

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	08/19/2019

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