Healthcare Provider Details

I. General information

NPI: 1861986986
Provider Name (Legal Business Name): STELLA O ADEBUSOYE DNP,PMHNP,FNP,APRNBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 MAIN ST STE 100
DALLAS TX
75201
US

IV. Provider business mailing address

2801 CASTLE CREEK DR
LITTLE ELM TX
75068-0340
US

V. Phone/Fax

Practice location:
  • Phone: 214-331-1200
  • Fax:
Mailing address:
  • Phone: 240-645-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number814209
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136863
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCAPN0001350
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: