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General NPI Number Information
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NPI Number | 1366351124
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Entity Type | Organization
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Legal Business Name | STAR RISE PRIMARY CARE PLLC
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Dates
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Enumeration Date | 09/05/2026
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Last Update Date | 09/05/2026
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Provider Practice Location Address
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Address Line | 10202 RYDER BND
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City | SAN ANTONIO
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State | TX
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Zip | 78254-4877
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Country | US
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Telephone | 401-617-4653
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Fax |
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Provider Business Mailing Address
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Address Line | 10202 RYDER BND
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City | SAN ANTONIO
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State | TX
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Zip | 78254-4877
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Country | US
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Telephone | 401-617-4653
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | OYINDAMOLA STELLA AKINKUGBE
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Credential | FNP
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Telephone | 401-617-4653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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