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General NPI Number Information
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NPI Number | 1093285504
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Entity Type | Individual
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Provider Name | KIKELOMO OMOLOLA DAWOTOLA FNP
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Gender | Female
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 3330 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-4531
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Country | US
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Telephone | 214-743-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 ANGIE LN
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City | DESOTO
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State | TX
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Zip | 75115-3870
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Country | US
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Telephone | 214-281-9480
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP139838
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License Number State | TX
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