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General NPI Number Information
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NPI Number | 1386510956
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Entity Type | Individual
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Provider Name | OLAKUNLE SUNDAY FASAN
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Gender | Male
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR STE 8370
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 713-260-2100
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Fax | 804-207-8849
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Provider Business Mailing Address
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Address Line | 29142 HAUTER WAY
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City | FULSHEAR
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State | TX
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Zip | 77441-2317
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Country | US
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Telephone |
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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 | 1215332
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License Number State | TX
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