=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336936731
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAMETU ADEBOYE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2025
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11104 W AIRPORT BLVD STE 121
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-3016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-215-0862
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1340 BRIGHT HILL DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77493-5182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-500-2410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------