Healthcare Provider Details

I. General information

NPI: 1912873977
Provider Name (Legal Business Name): ADESOLA AYILARAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 POPLAR HALL DR
NORFOLK VA
23502-3715
US

IV. Provider business mailing address

127 BASSETT AVE
VIRGINIA BEACH VA
23452-6876
US

V. Phone/Fax

Practice location:
  • Phone: 757-937-1495
  • Fax:
Mailing address:
  • Phone: 304-216-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number106046
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024195924
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: