Healthcare Provider Details

I. General information

NPI: 1326467705
Provider Name (Legal Business Name): BETTY ODEYINGBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 IRA E WOODS AVE
GRAPEVINE TX
76051-4213
US

IV. Provider business mailing address

6469 RIVIERA DR
IRVING TX
75039-4160
US

V. Phone/Fax

Practice location:
  • Phone: 502-644-9174
  • Fax:
Mailing address:
  • Phone: 502-644-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPI25457
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: