MEDICARE: KAYODE OLATUNJI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP133760	TX

General Provider Information

NPI Number	:	1184151979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYODE OLATUNJI NP

Provider Business Mailing Address
First Line	:	320 WILLOW SPRINGS DR
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-3357
Country	:	US
Telephone Number	:	248-346-4413
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 WILLOW SPRINGS DR
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-3357
Country	:	US
Telephone Number	:	248-346-4413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	07/21/2022

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