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NPI Code Detail

MEDICARE: OLED MEDICAL HOLDINGS LLC

MEDICARE: OLED MEDICAL HOLDINGS LLC
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1306660758
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLED MEDICAL HOLDINGS LLC
Provider Business Mailing Address
First Line : 12222 MERIT DR STE 130
Second Line :
City : DALLAS
State : TX
Zip : 75251-3236
Country : US
Telephone Number : 866-307-5484
Fax Number : 949-710-6127
Provider Business Practice Location Address
First Line : 12222 MERIT DR STE 130
Second Line :
City : DALLAS
State : TX
Zip : 75251-3236
Country : US
Telephone Number : 866-307-8454
Fax Number :
Authorized Official
Title or Position : APRN,FNP-C
Name : MARY CHINYERE OLEDIBE
Credential : NURSE PRACTITIONER
Telephone Number : 866-307-8454
Provider Enumeration Date : 11/12/2024
Last Update Date : 06/22/2025

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Directions to “OLED MEDICAL HOLDINGS LLC ” Practice Location

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