Healthcare Provider Details

I. General information

NPI: 1780485425
Provider Name (Legal Business Name): BANKOLE FAMILY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 TEASLEY LN BLDG 300
DENTON TX
76210-8302
US

IV. Provider business mailing address

3201 TEASLEY LN BLDG 300
DENTON TX
76210-8302
US

V. Phone/Fax

Practice location:
  • Phone: 940-239-3715
  • Fax: 361-355-8958
Mailing address:
  • Phone: 940-239-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLAWALE BANKOLE
Title or Position: OWNER/PROVIDER
Credential: NP
Phone: 940-239-3715