Healthcare Provider Details

I. General information

NPI: 1972847515
Provider Name (Legal Business Name): OMOLARA OLOYE ADELUSI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
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

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

V. Phone/Fax

Practice location:
  • Phone: 469-461-7286
  • Fax:
Mailing address:
  • Phone: 469-461-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0003457-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403623
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number263319
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1021681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: