Healthcare Provider Details

I. General information

NPI: 1093676025
Provider Name (Legal Business Name): IFEOLUWA ADENIKE AMUSAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9019 OVERLOOK BLVD
BRENTWOOD TN
37027-2735
US

IV. Provider business mailing address

9019 OVERLOOK BLVD
BRENTWOOD TN
37027-2735
US

V. Phone/Fax

Practice location:
  • Phone: 615-274-9767
  • Fax:
Mailing address:
  • Phone: 615-274-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number40235
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: