Healthcare Provider Details

I. General information

NPI: 1316892045
Provider Name (Legal Business Name): ABIMBOLA VINYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NITRO MARKET PL # 1051
CROSS LANES WV
25313-4408
US

IV. Provider business mailing address

800 NITRO MARKET PL # 1051
CROSS LANES WV
25313-4408
US

V. Phone/Fax

Practice location:
  • Phone: 681-313-6823
  • Fax:
Mailing address:
  • Phone: 681-313-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number113067
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: