Healthcare Provider Details

I. General information

NPI: 1114473303
Provider Name (Legal Business Name): FUNMILAYO OKUSEINDE MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9603 LAVENDER MIST LN
KATY TX
77494-2617
US

IV. Provider business mailing address

9603 LAVENDER MIST LN
KATY TX
77494-2617
US

V. Phone/Fax

Practice location:
  • Phone: 832-318-9050
  • Fax:
Mailing address:
  • Phone: 832-318-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number831275
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1018482
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: