Healthcare Provider Details

I. General information

NPI: 1598124190
Provider Name (Legal Business Name): OMIANA ABIOLA AJIBADE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 KATY FWY STE P200
HOUSTON TX
77024-1624
US

IV. Provider business mailing address

6720 BERTNER AVE SUITE P115
HOUSTON TX
77030-2604
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax:
Mailing address:
  • Phone: 832-355-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP129665
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP129665
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: