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General NPI Number Information
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NPI Number | 1235605064
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Entity Type | Individual
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Provider Name | BOLA OLASUNKANMI JAIYEOLA NP
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Gender | Male
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 400 ROSALIND REDFERN GROVER PKWY
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City | MIDLAND
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State | TX
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Zip | 79701-6499
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Country | US
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Telephone | 432-221-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 24218 SILVERSMITH LN
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City | KATY
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State | TX
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Zip | 77493-2683
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Country | US
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Telephone | 832-736-2652
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Fax | 405-645-7873
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | AP139389
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | AP139389
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024180467
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License Number State | VA
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