Healthcare Provider Details

I. General information

NPI: 1992295935
Provider Name (Legal Business Name): NOSIMOT TUTU ADEPEGBA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8067 W VIRGINIA DR
DALLAS TX
75237-3767
US

IV. Provider business mailing address

1701 WYLIE CREEK DR
DESOTO TX
75115-1716
US

V. Phone/Fax

Practice location:
  • Phone: 972-230-5601
  • Fax:
Mailing address:
  • Phone: 972-333-9798
  • Fax: 469-297-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP138648
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number694029
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: