Healthcare Provider Details

I. General information

NPI: 1356901581
Provider Name (Legal Business Name): ADEBUKOLA OBASANYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S MCDONALD ST STE 500
MCKINNEY TX
75069-5625
US

IV. Provider business mailing address

688 W PIONEER PKWY STE 120
GRAND PRAIRIE TX
75051-4861
US

V. Phone/Fax

Practice location:
  • Phone: 469-202-7572
  • Fax: 469-329-1044
Mailing address:
  • Phone: 972-642-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140289
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: