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General NPI Number Information
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NPI Number | 1346920477
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Entity Type | Individual
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Provider Name | OLUMIDE T REMI-JOHNSON PMHNP-BC, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 02/01/2025
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Provider Practice Location Address
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Address Line | 411 N WASHINGTON AVE STE 5200
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City | DALLAS
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State | TX
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Zip | 75246-1778
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Country | US
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Telephone | 855-204-2502
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Fax |
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Provider Business Mailing Address
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Address Line | 49 OAKTON DR
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City | ATCO
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State | NJ
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Zip | 08004-2489
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Country | US
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Telephone | 973-462-1868
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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 | 1151066
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ14883000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1151066
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License Number State | TX
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