MEDICARE: KEHINDE ROMOKE AMOSUN FNP

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	AP143304	TX

General Provider Information

NPI Number	:	1295376630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEHINDE ROMOKE AMOSUN FNP

Provider Business Mailing Address
First Line	:	3101 WILLOW CREEK CT
Second Line	:
City	:	NORTHLAKE
State	:	TX
Zip	:	76226-4061
Country	:	US
Telephone Number	:	214-395-8659
Fax Number	:	833-966-2321

Provider Business Practice Location Address
First Line	:	873 S STEMMONS FWY
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-5351
Country	:	US
Telephone Number	:	214-395-8659
Fax Number	:	833-966-2321

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

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	01/12/2026

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