MEDICARE: EUNICE OLUKEMI ADEBAYO

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	F12220254	MO

General Provider Information

NPI Number	:	1275228355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE OLUKEMI ADEBAYO

Provider Business Mailing Address
First Line	:	9015 BOOTH AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-4436
Country	:	US
Telephone Number	:	816-674-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	9015 BOOTH AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-4436
Country	:	US
Telephone Number	:	816-674-2542
Fax Number	:

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

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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