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General NPI Number Information
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NPI Number | 1144713611
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Entity Type | Individual
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Provider Name | ADEGBOYEGA OMOBA DNP, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 1141 WISHING WELL CT
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City | CEDAR HILL
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State | TX
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Zip | 75104-8255
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Country | US
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Telephone | 682-560-0666
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Fax | 817-422-0781
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Provider Business Mailing Address
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Address Line | 1141 WISHING WELL CT
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City | CEDAR HILL
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State | TX
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Zip | 75104-8255
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Country | US
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Telephone | 682-560-0666
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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 | C-APN.0001960-C-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2639996
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP137736
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 840719
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License Number State | TX
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