Healthcare Provider Details

I. General information

NPI: 1427902600
Provider Name (Legal Business Name): GRACEVILLE PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FRONTIER PKWY STE 110
PROSPER TX
75078-4291
US

IV. Provider business mailing address

8751 COLLIN MCKINNEY PKWY STE 1102
MCKINNEY TX
75070-1872
US

V. Phone/Fax

Practice location:
  • Phone: 469-884-7223
  • Fax: 469-429-5369
Mailing address:
  • Phone: 469-884-7223
  • Fax: 469-429-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUBUKOLA TEKEBA ADEYEYE
Title or Position: CEO
Credential: MD
Phone: 469-884-7233