Healthcare Provider Details

I. General information

NPI: 1316370919
Provider Name (Legal Business Name): MRS. KUDY DOLAPO ADELAKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 SOUTH LOOP WEST #261
HOUSTON TX
77054
US

IV. Provider business mailing address

6823 RIVER BLUFF DR.
HOUSTON TX
77085
US

V. Phone/Fax

Practice location:
  • Phone: 713-667-7202
  • Fax: 713-667-0712
Mailing address:
  • Phone: 713-504-1436
  • Fax: 713-667-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number588394
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: