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General NPI Number Information
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NPI Number | 1063088102
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Entity Type | Organization
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Legal Business Name | PRACTITIONERS WITHOUT WALLS, LLC
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Dates
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Enumeration Date | 05/30/2021
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 15333 N PIMA RD STE 305
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2717
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Country | US
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Telephone | 832-633-3186
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Fax |
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Provider Business Mailing Address
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Address Line | 21802 SILVERPEAK CT
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City | KATY
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State | TX
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Zip | 77450-5622
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Country | US
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Telephone | 832-633-3186
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. FUNMI OLUKOYA
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Credential | APRN, FNP
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Telephone | 832-633-3186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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