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General NPI Number Information
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NPI Number | 1225379050
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Entity Type | Individual
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Provider Name | OLAMIDE O ADELEYE NP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 1890 GOODMAN RD E SUITE 101
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9504
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Country | US
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Telephone | 662-536-1892
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Fax | 662-536-1859
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Provider Business Mailing Address
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Address Line | PO BOX 366
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City | SOUTHAVEN
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State | MS
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Zip | 38671-0005
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Country | US
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Telephone | 662-536-1892
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Fax | 662-536-1859
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 17031
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License Number State | TN
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