Healthcare Provider Details

I. General information

NPI: 1598307522
Provider Name (Legal Business Name): OLUJIMI IKUOPENIKAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9645 BARKER CYPRESS RD STE 100
CYPRESS TX
77433-5292
US

IV. Provider business mailing address

2202 FALCON BROOK DR
KATY TX
77494-7375
US

V. Phone/Fax

Practice location:
  • Phone: 346-250-6010
  • Fax: 346-200-3572
Mailing address:
  • Phone: 832-681-0706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License NumberAP142626
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License NumberAP142626
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License NumberAP142626
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP142626
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP142626
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142626
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP142626
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: