Healthcare Provider Details

I. General information

NPI: 1942802640
Provider Name (Legal Business Name): ADENIKE KOTUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20018 ALTON SPRINGS DR
CYPRESS TX
77433-4114
US

IV. Provider business mailing address

1155 DAIRY ASHFORD RD
HOUSTON TX
77079-3021
US

V. Phone/Fax

Practice location:
  • Phone: 720-365-4942
  • Fax:
Mailing address:
  • Phone: 713-799-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number943210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: