Healthcare Provider Details

I. General information

NPI: 1902761190
Provider Name (Legal Business Name): RACHEAL ADEGBOLA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8407 NEWPORT MANOR TRCE
RICHMOND TX
77407-3966
US

IV. Provider business mailing address

8407 NEWPORT MANOR TRCE
RICHMOND TX
77407-3966
US

V. Phone/Fax

Practice location:
  • Phone: 346-256-0459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1067765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: