Healthcare Provider Details

I. General information

NPI: 1942124565
Provider Name (Legal Business Name): OMOLARA OGUNADE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 US HWY 75
DENISON TX
75020-4584
US

IV. Provider business mailing address

820 WALWORTH DR
PROSPER TX
75078-1446
US

V. Phone/Fax

Practice location:
  • Phone: 214-714-6101
  • Fax:
Mailing address:
  • Phone: 214-714-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1236984
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: