MEDICARE: MRS. LILY ADWOA ODUKOYA PA

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	363A00000X	Physician Assistant	PA05763	TX

General Provider Information

NPI Number	:	1578755880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILY ADWOA ODUKOYA PA

Provider Business Mailing Address
First Line	:	7906 AUGUSTA CREEK CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7906 AUGUSTA CREEK CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-1701
Country	:	US
Telephone Number	:	773-983-5726
Fax Number	:

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	03/19/2026

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