Healthcare Provider Details

I. General information

NPI: 1740703487
Provider Name (Legal Business Name): BISOLA OYEKOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19411 MCKAY DR STE 150
HUMBLE TX
77338
US

IV. Provider business mailing address

17022 RYDAL GROVE LN
RICHMOND TX
77407-1928
US

V. Phone/Fax

Practice location:
  • Phone: 281-459-9181
  • Fax:
Mailing address:
  • Phone: 713-298-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134853
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number781415
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: