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General NPI Number Information
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NPI Number | 1073335436
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Entity Type | Individual
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Provider Name | KAFAYAT OLATEJU POPOOLA PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 207 N UNION AVE STE E
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City | ROSWELL
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State | NM
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Zip | 88201-3068
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Country | US
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Telephone | 575-363-3189
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Fax | 575-363-3188
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Provider Business Mailing Address
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Address Line | 809 VIRGINIA DR
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City | MANSFIELD
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State | TX
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Zip | 76063-5510
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Country | US
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Telephone | 346-235-7127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1057732
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License Number State | TX
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