Healthcare Provider Details

I. General information

NPI: 1578477840
Provider Name (Legal Business Name): AKINDELE MOSES AKINJOLIRE PMHNP-BC, PMH-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 ANDERSON RD NE
RIO RANCHO NM
87144-1483
US

IV. Provider business mailing address

3129 ANDERSON RD NE
RIO RANCHO NM
87144-1483
US

V. Phone/Fax

Practice location:
  • Phone: 301-765-4545
  • Fax:
Mailing address:
  • Phone: 301-765-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number89838
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: