Healthcare Provider Details

I. General information

NPI: 1316333479
Provider Name (Legal Business Name): OMOLOLA K OLOYEDE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24044 CINCO VILLAGE CENTER BLVD STE 100
KATY TX
77494-8433
US

IV. Provider business mailing address

24044 CINCO VILLAGE CENTER BLVD STE 100
KATY TX
77494-8433
US

V. Phone/Fax

Practice location:
  • Phone: 346-517-7874
  • Fax: 346-205-0499
Mailing address:
  • Phone: 346-517-7874
  • Fax: 346-205-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number696905
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP144755
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number144755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: